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- FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT !d 2,2_Permit No. ------------•----•--- <br /> --------------------- ---------------------------------- <br /> (Complete in Triplicate <br /> -/ <br /> ------------------- -------------- -- ----- -- - - • <br /> _ _ _ This Permit Expires 1 Year From Date Issued 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 /> - <br /> egulations: <br /> J08 AbDRESS�LOCATlO 1- 7 ------- - ------------ <br /> -----------CENSUS TRACT -------------------------- <br /> Owner's Name -_-- -- ------- Phone <br /> --.-------- <br /> -------------City - -- - --- ------ ---------------------•-•------ <br /> Address -----------1I' --- --- - ----- -- <br /> - --- -- -- --- <br /> License <br /> Name -------- -. License# ---- --_.----- <br /> ---- Phone --------------------- <br /> Installation will serve: Rssid ce [ Apartment House[] Commercial []Trailer Court ❑ <br /> Motel ❑Other -------------------------------------------- <br /> --------------- <br /> t <br /> ------------------------------------------- <br /> 1 <br /> Number of living units ----- Number of bedrooms --c-----Garbage Grinder ------------ Lot Size ------------------ ----- <br /> Private <br /> Water Supply: Public System and name ----------------------•---------------------------- ------------------------------------ <br /> " `"-` ` ; ClayPeat E] Sandy Loam Clay-Loam❑ <br /> Character of soil to a-depth of 3 feet: Sand❑ Silt❑ ❑ <br /> IHardpan ❑ Adobe.❑ F;II Material ------------ If yes,type ---------------------------- <br /> (Plot;plan, showing size of lot, location of system in relation oto wells, <br /> buildings, etc. must be placed on reverse side.) ` <br /> NEW INSTALLATION: (No septi�tank or seepage pit permitted if public sewer is available within 200 feet,) V <br /> PACKAGE TREATMENT { ] SEPTIC TANK[ ] Size------------------------------------------------ Liquid Depth -------------- <br />` ,."' , <br /> i Capacity t -- ---- --- Type;_-.--------------- Material---------------------- No. Compartments <br /> I Distance to nearest: Well ------- --- ------------- '-= Foundation ----------------------.Prop. Line ------------------------ <br /> Distance <br /> ---•----- <br /> - � - - F __ Total Length -------- <br /> 'D' <br /> ----- •�+ <br /> ------- ---- ------- Len th',of each line----- ------------------ g --------- --------- - <br /> LEACHING LINE ' [ ] No. of Lines - - g �,P. <br /> -Depth Filter Material --- ----------------•----------------------- <br /> 1 'D' Box --------�=--vType Filter.Mafierial _-_'--_'_-----____-- <br /> t 1 -------------- Foundation ------ Property Line. -_--------------. <br /> p;stance to nearest- Well -___-___-- ---- ---------- -- <br /> SEEPAGE PIT { ] Depth --------------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No <br /> 1 <br /> 1 Water Table Depth --------------------------------------- ------ Rock Size <br /> 1 ------Foundation -------------------- Prop. Line ---------------------- <br /> Distance to nearest: Well --------------------------------- <br /> Date ----------------------------------) <br /> i <br /> REPAIR/ADDITION(Prev. Sanitation Permit�# ------------------- <br />{ Septic Tank (Specify Requirements) --------------- - ------------------------------------------------ - <br /> Disposal f=ield (Specify Requir ents) _ GL------1•-- - ---- ---------------------- -- - -- ----- ----------- ----------- <br /> Lzzl-- '4 ` - - --- - ---. - ----------------- <br /> IE { <br /> ---- ------------------------------- -------------------------------------- <br /> - <br /> ----------------------------- ------------- - - <br /> s {Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be stone 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 agents signature certifies the following: <br /> "I certify thaP mance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to becomer man' Co ensation laws of California." <br /> Signed --------- ---=------------- OwneBY - -- - -----F --------------- Title- <br /> owner] <br /> FOR .DEPARTMENT USE ONLY <br /> -�Z <br /> APPLICATION ACCEPTED BY - ----- -- - ----.- ---x ------------------------------------ - <br /> ------------------ DATE _-�_'�`fp----•-------------- <br /> ---` <br /> BUILDING PERMIT ISSUED ----------------------- --------- ------- "----- <br /> -------•--------------DATE ------------------------------------------- <br /> 4 ADDITIONAL COMMENTS ` <br /> - ----------------------------------------------------------------------=------------------ -------- <br /> ---------------------------------- - __ <br /> ----------------------- <br /> - - ----" - <br /> `� -------- ------------- Date --------- ------- -----• ------ <br /> -------- <br /> 1-� <br /> Final Inspection by: /.��r-_�__f`��"�:.�------------- --------- - - - <br /> F 4r 1 <br /> SAN -JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M. <br />