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F=OR.OEFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br />:.:...................................4---.....----------- <br /> Permit No. <br /> lCvmplete In Triplicate) <br /> _.....K <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 construd 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 ...... .Q1i/ .............d9r.5................... <br /> !Bv...-..... G� <br /> ...CENSUS TRACT ....... _ . ........- <br /> Owner's Name ...._._ v <br /> ..Phone ....�.O.P�.��...:�---• <br /> Address !rl City <br /> .... ... ......... .:.............-. .. <br /> Contractor's Name C� 7 � /� __..License # .`�.... <br /> h..................... ..--•.... Phone <br /> Installation will serve: . Residence 0 Apartment House] Commercial(]Trailer Court <br /> Motel ©Other 41 <br /> . <br /> Number-df livingunits:.7 -:.. Number of bedroom - -:_.--.-Garbgge�Grinder 777=Lot-Size ....... .......—T--: ....:.....::.... <br /> Water Supply- Public System and name '� a <br /> Pp Y' Y ........................ <br /> �. .�. _ _ . ..Private Q/ <br /> Character of soil to a depth of 3 feet: Sand ] Silt❑Clay-- --Peat-Q--•r'SandyAoom g}—'Clay Loam Q'l <br /> , •Hardpan_p Adobe-Q - a <br /> Fill Mterfal ...: ...Wif es- a—:..:........ . <br /> Y type ...... <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) ``a�► <br /> j <br /> NEW INSTALLATION: (No-septic-tank-or seep ge-pit-:per0hitted if public sewer.is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] 5EPTIC TANK x '*� Size__. V `r <br /> { � .fi` 1K.__P.._.......,liquid Depth ................. . <br /> di <br /> - - <br /> Capacity Type 2 Material....................... No. Compartments --�.... N <br /> h.Distance.to nearest: Well .- -5.`.� �____________________Foundation ... 5 ..... Prop. Line ...r3� �.. <br /> LEACHING LINE .34", lV- <br /> --------- ✓' ",7 <br /> ( ] No. of Lines lF;Length of ach line...----- Jl Total Length ..... ?t :}_. <br /> 'D' Box .._.:,:_... Type Filterf:Materlal`6./..�X­�" _ -Depth Flter-S 'atericl :3-._r. <br /> At....................... <br /> Distance to nearest Well _.• .................. Foundation ..._.-..._...... Property Line ............ <br /> SEEPAGE PIT .............. Rock Filled Yes[] No �7 <br /> O Depth Diameter ._.... Number --:..... <br /> -Nater Table-Depth------'"_ _ -..::Rock Size"...." '.. ,.. . -_ <br /> Distance to nearest: Well _____•---_---- - ..._.::_-_Foundation ------- Prop. Line <br /> 4 <br /> REPAIR/ADDITION(Prey. Sanitation Permit# --------------------------.......-.......... Date ............... .....) ' <br /> SepticTank (Specify Requirements) .......•-----------r.,_..--------------- ..................................................................................................... <br /> Disposal Field (Specify Requirements) ---------------- ---------• -•--•------......-•-- ......................................... ............................. <br /> , <br /> ---- ------------------•--•------- ..................... -----••---•: .._......................._. <br /> ---.---- ----­-------­----------------- ------•------------------------------------.............. .............................. ................................................ <br /> {Draw existing and required addition on reverse side) <br /> I hereby certify that.l 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. Horne owner or licen- <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 /> Signed --- owner <br /> - <br /> BY ---------------•--------------•-•---------•----••---•------- - - 3itle l(J .... C9- CJ <br /> (If other than owner) - <br /> J <br /> Fn <br /> Cp DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----------------- �-� <br /> _ -: ..DATE �.. ., <br /> BU iLDING'PERMIT-ISSUED ...... ..:".:..-: --------------- --- ----------• -- ------------ - --. - -----.....DATE - ...................... <br /> = <br /> ADDITIONAL COMMENTS ------------------------------------------:.... <br /> ---------------------------------------------------------- .................................. --------------------..._.-.- <br /> Final inspection by: - ------- --------- ......-----�'..`' .��.::.-Date .. .. _" . <br /> EH 1.3 2h 1-68 lieu. �. ... <br /> SAN JOAom :LOCAL HEALTH DISTRICT 8/74 3m <br />