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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ----- ---- - ------ - -- -_ - - - _-����� <br /> (Complete in Triplicate) Permit No. - <br /> ---------------------------------------------------------- zG_?511 <br /> A - Date Issued <br /> R.------------- __-----_---_-___________----- This Permit Expires 4 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 /> V. <br /> JOB ADDRESS/LOCATION,.-ZPv---�------- /-p c t ' .......elo-- -----------------------CENSUS TRACT --------------------•- <br /> ?� - �s. ?------------------------------------------ -------------------Phone � ----- __--- <br /> Owner's Name ------ -- ,%' �- <br /> Address ---------- ------------- -------------°----------------------------- ------ City --------------------------------- <br /> Contractor's Name ---- •---5 1-------e --------------------License --- PhoneInstallation will will serve: ._—Residences Apartment House❑ Commercial ❑Trailer Court ;❑ <br /> Motel IN Other -' -------------------------- <br /> Number <br /> --- ------------------ <br /> Number of living units:_____---_ Number of bedrooms -_---Garbage Grinder,-_,;W0_- Lot Size --_-7-�[ --------- <br /> Water Supply: Public System and name ------ ---------------•------------- -----------------_--------=----------'-----------------------------------Private <br /> { It <br /> Character of soil to a depth of 3 feet-j Sand'❑ Silt❑ Clay 0 Peat❑ Sandy Loam A� Clay Loam E] <br /> ',Hardpan ❑ Adobe ❑ Fill Material -----.----- If yes,type --------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, .etc. must be placed on reverse side.) <br /> Y E } <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( I SEPTIC TANK,g Size-` _S_- - _-------_ Liquid Depth -_—_-__-_-------__ <br /> Capacity1,;?,9_,7Typw3 Materiallo. Compartments <br /> Distance to nearest: Well -f-_-___----_-------Foundation ------------- Prop. Line --- <br /> LEACHING <br /> -LEACHING LINE No. of Lines ______ ______________ Length of each line__._-.r_�5 ----- - <br /> 'Tota l length J0 <br /> - ------------- <br /> 'D' liox IV -- Type Filter Material _RA k-__-Depth,Filter Material ---1-19---------------------------------Z <br /> Distance to°nearest;-Well-n,3- 49--`------ Foundation .-fid__----------_- Property Line. _- -............. <br /> r <br /> SEEPAGE PIT JC) Depth --- P--- Diameter _AL3- ' Number _-___ ------------ Rock Filled Yes Rr No 0 <br /> Water Table Depth --------------------------------Rock Size . tea -fes 1 <br /> Distance to nearest: Well -/.00_-`-------------------------Foundation -_., `------- Prop. Line --; --­-----------. r . <br />` REPAIR/ADDITION[Prev. Sanitation Permit# -------------------------------------------- Date -----------------------'=----------1 <br /> SepticTank (Specify Requirements) ---------------------------------------------------------------------I------------ --------------------------------------------------------- <br /> Disposal <br /> ------------------ -,..._Qisposal Field (Specify Requirements) --------------------------------------------------------------I----------------------------------------------------- - -- ---------- <br /> (Draw existing and required addition on reverse side)_.t-.., 'r" <br /> I hereby certify that I have prepared this application and that the work will be done in :.dccordance 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 /> "1 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 /> Title ----------------------------------------------------------------- ------ <br /> 8Y - ( - - -----� --'---- --s�------ -fid ---------- - � <br /> If other than o, d <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----------------------------------------------------------------------- DATE ---- a ------------- <br /> BUILDING PERMIT ISSUED - ------ --------------------- ---------------- -------------------------------------DATE -------------•----------------------------- <br /> ADDITIONALCOMMENTS -------------------------------------------------------------------------------------------------------- ----------------------------------------- <br /> -- ----------------------•- <br /> - - - -------------------------- ----- ----k <br /> Final Inspection by: --- -----------Date - -�-�----- ---------- <br /> SAN JOAQUIN LOCAL HEAD H DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M <br />