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FOR OFFICE USE: ""- -.-- <br /> ..................... <br /> . ............ APPLICATION FOR SANITATION PERMIT <br /> -•-••• <br /> (Complete Triplicate! Permit No. .7��......�Sr <br /> This Permit Expire 1 Year from Date F nN'�TY <br /> p Issued Date,Issued <br /> Application is hereby made to the San Joaquin Local Health District for a <br /> j described. This application is made in compliance with County Ordinance No . 549 and existing Rulesermit to constru'a andtland Regutions :ern <br /> JOB ADDRf5S/LOC TION ' <br /> ...-,----._S.L_.q. .. ... .Y1 ICY �... ..CENSUS TRACT <br /> . .... . .. .............. <br /> Owner's Name ........ <br /> Address -- .8_ one ... ........ <br /> -------`t'...�'._��... _ _..City,_ <br /> Contractor's Name � �j . . ----------•---.....---••---- <br /> '� Ji 'L ..License .�.g ... <br /> Phone ......:......... <br /> Installation will serve: •-••••---•---- <br /> Residence. Apartment House fl Commercial oTra€ler Court <br /> Motel❑Other...... <br /> ____ <br /> Number of livin units:_____ <br /> g �.-•--- Number,of bedrooms .._.Garbage Grinder <br /> ----• tot Size .. <br /> Water Su .... <br /> Supply: Public System and name ....__.-. <br /> �...........................Cla..........Private <br /> Character of soil to a depth of 3 feet: Sand Q Slit QL,Clay �,,/ <br /> ❑ Peat Q Sandy Loam t y Loam ] <br /> • <br /> Hardpan p ❑ . Adobe [{ F111 Material ..._........ if yes,type <br /> ............... . .......... - <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse-side.} ¢ <br /> NEW TALLATION: (No septic tank.orieepage pit perm)tied if ubilc sewer.is available within 200 feet,) <br /> PAC KAGE TREATMENT .I ) <br /> SEPTIC TANK ���.-�--g _....... liquid Depth �- S <br /> Capacity Q.p Type !��at�rlal----: <br /> �.-�.No:--Cam artments - <br /> p � _ <br /> Distance to nearest: 1A%eri . . . ...:.Foundation --p_. <br /> LEACHING LINE (K Prop. <br /> No. of lines _... Length of each Iine.-__: ko `" <br /> -----...._ _.. .-__ Tota! Cen-tFt " <br /> 'D' Box ria`!.. ... . <br /> .....�- Type .filter Material .... .. .......Depth °.fitter Material <br /> - . Number <br /> . -- <br /> Distance to nearest: Well •..'.J. <br /> ......�.-."'..' <br /> ........._....... <br /> EPIT <br /> SEEPAGFoundation -/114-- <br /> /4 - Property Line Depth ---- ------ Diameter .......... ..... Num r ........ Rock Filled Yes'[] <br /> .. i <br /> No f <br /> Water'Table Depth <br /> .........Rock Size <br /> Distance to nearest: Well ..Foundation <br /> - <br /> --••••-----._.. Prop. line <br /> REPAIR/ADDITION(Prev. Sanitation Permit' ` "" """" <br /> Date ._..------•••• ......... <br /> Septic Tank (Specify Requirements) i <br /> •-•---------••----•-• .................................Dis osal Field _......---�--••. <br /> ...................._........ <br /> p (Specify Requirements) -------------- , <br /> ---• •- ---•--••--------------------------....... .................. <br /> ---•----------- <br /> ---­-----­-----­-------- ---_................................................................. <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certify that I have prepared this application and that the worry will be .done in accordance with Son. Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:District. Nonce ow <br /> sed agents signature certifies the following: ner or licen- <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 Iaws�of California." <br /> p - <br /> Signed --....•_..._ <br /> _... --- Owner <br /> -----. <br /> - <br /> By ....... --------- ------••- -- ---- <br /> -- - --- ----- --- - Title _. <br /> (1 other than owner) <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _-._.. •� � <br /> •-• -------- ----- - <br /> BUILDING PERMIT ISSUED ---•----_�_..-----...... , <br /> ADDITIONAL COMMENTS - .........................DATE - <br /> ------------•----------------------------- -- _ _ <br /> __._.I--------• ------- <br /> ----•-----------------------•------ •....... <br /> Final Inspection b <br /> 1-3 2h 1--613 rev. 5H Date _-.. -_..`-0-_7._�-...-�- � <br /> SAN .l.OAQUIN LOCAL HEALTH DISTRICT 8/71 3M <br /> t <br />