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i <br /> FOR OFFICE USE: " JAPPLICATION FOR SANITATION PERMIT . <br /> -----------------=---------------------==-- Permit <br /> (Complete to Trip)irate) If No>7�_-__ <br /> This Permit Ex 1 Year Expires------ p From Date Issued <br /> Date Issued .E:__c�Q._:70 <br /> --------------------- ---------------- <br /> - <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and install theswork herein <br /> described. This application is made in compliance with.County Ordinance No. 549 and existing Rules And Regulations: <br /> :- ti ; r__ -- CENSUS TRACT ADDRESS/LOCATION ' _ -- ------------------------ n --. <br /> - <br /> -- - _'Owner's Name T r <br /> ' <br /> - ------------ 1 <br /> - - - -- --------------- <br /> Address -^==------�------------------•------------------------- - City ---------------------------------------------- <br /> Contractorl Name - � _;--- -•-----=� -----------------License # Phone,__'1'�'�'---`a�=-'�F-: <br /> Installation will serve: Residence 0 Apartment House❑ Commercial :❑Trailer Court l❑ <br /> Motel ❑ Other --------t----------------------------------- <br /> 4 Number of living units:-__ ___-_ Number of bedrooms ___ ___Garbage Grinder Lot Size 7` - I`---_-- `------'--------- <br /> Water <br /> _ _Water Supply: Public System and name ---------- ------ ------ ------ - ----- -- --- --------------------------------- ----II---Private []' <br /> r <br /> Character of soil to a depth of 3 feet: Sand❑ Silt•❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam,[:] <br /> {' t Hardpan [] Adobe ❑ '. Fill Material ------------ If yes,type ----------------------------- <br /> (Plot <br /> -------------'------------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings,_etc. must be plated on reverse side.) <br /> iM \ <br /> NEW INSTALLATION:: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT {`]c SEPTIC TANK [`, Size__ t -----------� /V ____ Liquid Depth --------------------------- <br /> :-.---__ __________ _ _ <br /> Capacity �I - Type _ __ - Material __.__4__2_ _ No. Compartments .__:________. <br /> -. - �� ` <br /> _Foundation _____!f�_ Prop.!Line __° >_____ __________ <br /> Distance to nearest: Well ----���`=----------------------- _ '--------- <br /> LEACHING LINE No. of Lines ______ _______________ Len th"of each line- -- t___-_-�- Total Length ._/ �" ---------------- <br /> r . I <br /> D' Box .% '-- Type Filter Material._€.- *! --- -Depth Filter Material =f-j--_--_I-_­ ----­-------------- - <br /> ii - <br /> Distance to nearest: Well - _1 -r--- -_ Foundation __-_Z_i`__-.________ Property Line. --- <br /> SEEPAGE PIT [ ,j Depth _�__z----------- Diameter '' f P---- Number ______: -�'_�_---------------- Rock Filled. Yes .Q No .C] <br /> i <br /> Water-Table .Depth--------- -------------------Rock Size -_e'-II/----r---------------- ; <br /> Distance to nearest: Well ------------------ -__ Foundation __-_________________ f rb i Line ____________._______ <br /> REPAIR/ADDITION(Prev, Sanitation Permit# -------------------- ---------- '----;----- Date -------------------------- <br /> Septic Tank (Specify Requirements) ------------- ------------------------------------------------------' -=--------------- ---=-.---------- <br /> 'Disposal Field (Specify_Requirements).------------------------------------------`-- -------------------------------------------i``-------------- --------------- <br /> I <br /> ----------------------------------------------------------- --=---------------------------------------------- -------------------------------------------------------------:---------------- ------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or llcen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> By <br /> ------------------------------ <br /> --------------------------- ------------ ---- Owner <br /> Signed •� --------------------- <br /> r <br /> S ------- --------- ----- r: --- `- ------------------------ Title - -- <br /> (If other than owner) ' <br /> EPARTMENT USE ONLY <br /> APPLICATION ACCEPTEDBY ------- -------------------------------------------------- ----- DATE _ c = ------------- <br /> BUILDING PERMIT ISSUED -- ----- -- --- -- _1VAE 'Ik <br /> - - - -- ---- ------------ ----=------ <br /> ADDITI AL COMMENTS _ _ __ <br /> . ------ �' --- I Q -- ----------------- <br /> ------------------------------ ------------- <br /> --------------------------------------- -- - --- - --- ------ ----------------------------------------------------------------------------------------------------------------- ------------- <br /> D <br /> Final Inspection by -- - ------------------------------------------------------------- Date -0------ <br /> SAl� JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'6$ Rev. 5M. <br />