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a <br />FOR OFFICE USE: <br />. ` <br />-------------------------------- <br />--- ---------------- --------------- <br />-------------- <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) ; <br />This Permit Expires 1 Year From Date Issued <br />Permit No: - �_.-________-_.. S <br />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 gmade in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br />J08 ADDRESS/LOCATION .__ 1 "_f_ ���CENSUS TRACT <br />--------- <br />------- <br />------ <br />_----- ----------------- <br />-_ -Owner's Name T----- -----------------------------------------------------------------Phone -- "_gC 5 ._... <br />Address ------ ---ih--------- - <br />. City ----- - <br />Contractor's Name Se F -------•--------------- -------------------------------------------------- License # --- :-------------- Phone <br />Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ;❑ <br />Motel ❑ Other -- �} (]j <br />Number of living units:___------- Number of bedrooms _1_____Garbcge Grinder NO___ Lot Size _ _ Wxe. <br />.---- <br />Water Supply: Public System and name ----------------------- __________--Private ❑ , <br />------------------------------------------------------- <br />Character of soil to a depth of 3 feet: Sand'❑ Silt ❑ Clay .❑ Peat ❑ Sandy Loam .0 Clay- Loam ❑ <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 />NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,j <br />PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size______________________ _ _ Liquid Depth -------------------- <br />Capacity <br />Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ----------------- <br />Distance to nearest: Well --------------_ ____________- _---____Foundation -.__ ------------------ Prop. Line --------------- .------ <br />' <br />LEACHING LINE [ ] No. of Lines ----------- Length of each line____________________________ Total Length ----------- ___ <br />-------------- <br />'D' Box ------------ Type Filter Material ___________________Depth Filter Material ---________-_._____ <br />-- ------------•------ <br />Distance to nearest: Well ________________________ Foundations __ -------------------- Property Line. -------- .______-__-_ <br />SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number _.'______-----------""""-- Rack Filled Yes [] No i❑ <br />Water Table Depth ------------------------------------------------ Rock Size ------------------------ :. <br />Distance to nearest: Well----------------------------------------Foundation-------------------- Prop. Line........................ <br />REPAIR DDITION (Prey. Sanitation Permit F# _____-.-___________________________________ Date ----------------------------------- <br />tic Tank (Specify Requirements) ------------------------------------------------------------------------------------------------ <br />---------- <br />Disposal Field (Specify Requirements) _________ ______________-____{ <br />' o .Q: - (0- - - :.1 Kla------- -------------------------------------------------- --- <br />------------------- _----------------------------------------------------- � .---- F <br />(Draw existing and required addition on reverse side) <br />I hereby certify that I 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. Home 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 becom s ct to s Compensation laws of California." <br />Signed'A---L� y ------------------------------------------------------ Owner <br />By---------------------------------------------------------------------------- -------. Title --- - --- -------------------- <br />llf other than owner) <br />- -------------- <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY_ !\` .-------------- DATE --- 11_' -A& -n1____________------ <br />BUILDING PERMIT ISSUED-------------------`---------------------DATE------------ <br />NAL COMMENTS---------------- _____ _ <br />----------- --- <br />. 4 ­- _%A ----- -0 ----- <br />-A--` <br />-- <br />-------- - --------- ----- AiDow �__ k�;� , - � � k. ii --- <br />i'�"°---------- <br />Fina! Inspection by: ---------- ------------- Date----fj-_. <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />E. H. 9 1-'68 Rev. 5M <br />