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.. APPLICATION FOR SANITATION PERMIT <br />�. ........................... 7 7 <br /> • ..... Permit No. .. ........; <br /> lComplete in Tripllcate? <br /> ......................................................... This PerSe}it Expires 9 ea Frem Date Ossued .'�.Date Issued <br /> Application is hereby mode to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> dcsuibed. This applicatiori-Is made ln:[ompliance with County Ordinance No. 549 and existing Rules and Regulations, <br /> .JOB ADDRESS/LOCATIO ��.��`� .1.���� :1!�. ��C!�..X .. CENSUS TRACT ....... <br /> F Owner's Name . '�.`Vl::. .................E .,. .. . ............Phone .:1 . ........ <br /> Address ! 7rr- ... r��z�C -..1`x.6...................City .J ..._ <br /> Contractor's Name..:-; c , --- ..License # _,1 Phone <br /> f ..� �'.. <br /> Installation will serve, Idence partmeot'Hause❑ Commercial❑Trailer Court 0 \\\ <br /> . Motel❑Other } . <br /> Number of;living units,.......'--.. Number of bedrooms,_......Garbage Grinder -------_____ Lot Size .............................................. <br /> Water Supply: Public System and name -- ------._.___•.___..___.__...._...-..........................................Private -7' <br /> r 4 <br /> i Character of soil to a depth of 3 feet: Sand❑ SlittCj .h Clay ❑ Peat Q Sandy Loam ❑ -Clay loom ❑ <br /> Hardpan[] Adobe`.❑ Fill Material ............If ye:,type............... ............ <br /> (Plot plant showing size of lot, location of system!in relation to wells, buildings, etc. must be placed an reverse slde.) 76 <br /> NEW INSTALLATIONS {No-septic tank or seepage`pit permitted if public sewer is available within.200 feet,, <br /> I <br /> PACKAGE TREATMENT [ ] SEPTIC TANK I Size._. Liquid Depth .'.................:...... <br /> Capacity -Type ............... ... Material.::.................: No. Compartments _ .......... <br /> k -• Distance to nearest: Well .. ... ...Foundation LES! .......... Prop. tine tires. �.............. <br /> LEACHING LINE, [ ] No. of Lines ..................L.... Length of each line............................ Total length ............................ ' <br /> s —"D.'Sox - Type,Filter Ma#erlal. eDepth Filter Material ...r............................... <br /> • , ,Distance.tosnearesh Well ..._... ............ Foundation ........................ Property Line ............... .... <br /> ..... <br /> SEEPAGE_ PIT I ] V <br /> Depth ...................--- Diameter ................ Number ----.-- Rock Filled Yet ❑ No Q r`I <br /> r � <br /> Water Table Depth ._ •...Rack Size ......................:.::::.:.. <br /> Distance to nearest, Well ..Foundation .... prop. llns `..................... I <br /> REPAIR/ADDITION Wrev. Sanitation Permit <br /> .......................•........•........... ®ate .................................. � <br /> Septic Tank ISpecify Requlremen#s1 .........................................!. . ---- ... ........................ <br /> .. ..........._................ <br /> . �'X' - . <br /> Disposal Field ,Specify Requirements) ........... ....... ....... ...... ...... ........ . •----.....................:.............................• I <br /> .......�-=. ..........--•....................... ------------ .............. ............ .............................. � <br /> i _................. .. - ..l.. <br /> j iDrow existing and required addition on reverse side, <br /> ,1 hereby certify that I have prepared this application and that 4he 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 licen- <br /> sed agenis signature certifies the following: <br /> "i certify thouin the performance of the work for which this permit Is issued, t shall not employ any person in such manner i <br /> as to becjorn 'sub act-two Warkman'-s- ompensation laws-of-California." <br /> Signed . r -----------------------------------------------.. Owner <br /> By ...•-- � �........ ........�..a..-�................... Title ............................................................ ...........! <br /> Ilf otherthan owner,-. <br />{ FOR PART T US NLY <br /> APPLICATION ACCEPTED BY <br /> . . ..............:...... DATE-.:��Z`.. <br /> BUILDING PERMIT ISSUED . ........ DATE - .. <br /> ADDITIONALCOMMENTS .. ..... ............ ............................•--....---.........----•--.......---------• ---............................ ........ <br /> ... .............. .......•--•-----•--•--•-----•-••--•-•••--------.......................................................................---................. i <br /> . <br /> . . ................................ .. ... ---..o. ........ ...... ---...... <br /> ..... . .......... . .............. <br /> ......... <br /> ................. ....... .......... ........................................... <br /> Final Inspection by: ........-. ... ..••••••...............................................:... .........©ate ..� .—./ ... �.._...-... <br /> IIs 13 24 1-68 Rev. <br /> SAN IOAQUIN LOCAL HEALTH DISTRICT 8/74 3 <br />