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E <br /> FOR OFFICE USE- , APPLICATION FOR SANITATION PERMIT Q <br /> _:: <br /> --------- ---- - 1 Permit No. r -I- <br /> . -•,._ {Complete in Triplicate) ,, , <br /> ---------------------------------------------------- N. x <br />� -- ... _Date Issued -------3 � <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION --- � - ----- ------------------------- -------------------CENSUS TRACT ------------------ ------ <br /> Owner's Name ---- - ----------- ------ - = Ph <br /> one <br /> Address ------------------ =------ --------------=----- ----------------- City ----- ----------------------------------------- <br /> Contractor's Name r -- - -•-------- --- ---- 1----.License # - ----- <br /> Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court [� <br /> Motel ❑Other -------------------------------------------- <br /> Number <br /> --------------------------------------- --Number of living unitsJK�___ Number of bedrooms ------------Garbage Grinder__.=:—t_'-:__-Lot Size ...... - • <br /> Water Supply: Public System and name ----------------------•--------•-- ---------------------------------------::----------------------------------Private ( <br /> Character of soil to a,depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam El <br /> ...' Hardpan ❑ Adobe X Fill Material _-___._---- If yes, type ---------------------------- F 1 <br /> y t � <br /> (Plot plan, showing- size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK f I Size-- --- ---------------------- ----- ------------ Liquid Depth ------------------.-,----- <br /> F jr <br /> Capacity --------------------- Type ----------------- __ Material------------------------ No. Compartments ---------•-----...-•-- <br /> �'� Distance to nearest: Well -----------------------=------------Foundation -------------- ------- Prop. Line ----.---------------- <br /> LEACHING LINE: [ ] No. of Lines _____________ ________ Length of each line---------------------------- Total Length __--__-____.__-.---------- . <br /> 'D' Box ------------ Type Filter Material --------------------bepth Filter Material ------------------------------•------•--•--- <br /> x Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line. _____-______._.:_------ <br /> SEEPAGE PIT `W ; Depth _____ --�___ Diameter _____ Number _________ Rock Filled Yes �p No ❑ G <br /> ' Foundation �f. --------------------- <br /> Water <br /> Pr--- Line <br /> v Water Table Depth Rock Size <br /> ' _ / <br /> ........---- ..Found n <br /> Distance to nearest:,Well-..___- -- _- Prop. <br /> REPAIR/ADDITION(Prey. Sariitation Permit 00__�- -------------------------------------- Date ---------------------------------- <br /> 1 ---------- <br /> E Septic Tank (Specify Requirements) ---------------- ------------ -- <br /> �:--------- --------------`- - <br /> ------------------ - ---•.-•--- - ' <br /> i <br /> Disposal Field-(Specify.-:Requirements);.----- - ------- ---- <br /> // - 4 I ---------------------------------------------------------------- ------ <br /> (Draw existin 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 Rule's and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following I , <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ---- -------- { Owner <br /> BY `'r Title - <br /> (If other than owner) <br /> ' ( FO PARTMENT USE ONLY <br /> F APPLICATION ACCEPTED.•BY ------- - -- ---- -------------------------------- --------- DATE _. .- --7 ----------- ------ <br /> BUILDING PERMIT­ ISSUED -------- ---- ----- --- -------- ----------------------------------------- -------DATE - ----------------------------------------- <br /> ADDITIONALCOMMENTS ---- - -- -- --------------- -------- --- ----------------------------------------------------------------------------------=--------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> = ---- -- --- -------._ <br /> r --- --- ----- --- <br /> Final Inspection by: --------f--- -- --- -- GZ '� ------.Date " <br /> I f r <br /> SAN JOAQUIN-- -OCAL HEALTH- DISTRICT <br />