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P-OR OFFICE USE: 7 <br /> WLICATION FOR SANITATION PERMIT <br /> --------------------- ----------------------------------- Permit No. - <br /> (Complete in Triplicate) <br /> -------------------------------__------__________----_ This Permit Expires 1 Year From Date Issued Hate issued <br /> --3 _�-!-. <br /> Application is hereby made to the San Joaquin ocal Health-Distric—t�fo a-,permit to c nd structand install the work herein <br /> described. This application.is made in compliance w�h ounty Or finance N o. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCAThON �U_D-� -------1- - ----Z7 00 <br /> CENSUS TRACT --- ----------------•_.-. I <br /> Owner's Name ----- IG,� A��--------AC7�/------------------ -------- --- <br /> ---------- Phone , . - = <br /> Address / -------all0alleTr------------•------------------------------------------------- City ------------------------------------ ----------------- <br /> Contractor's Name ------A_Xt----�uL1-P----------------- -- --- /��f <br /> - ----------=-------.License #�',�"�s'x�----- Phone ��`�-='---------•---------- <br /> Installation will serve: Residence ER-A-partment House-[] Commercial :❑Trailer Court ;❑ <br /> i <br /> Motel ❑ Other ---------------------- --------------------- .y <br /> Number of living units:------ Number of bedrooms ---- ____Garbage Grinder _- --- Lot Size - c <br /> Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------.Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Rr Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ if yes,type ---------------------------- 1(� <br /> (Pl'ot plan, showing size of lot, location of system in relation to wells, buildings, .etc. must be placed on reverse side.) 0 <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> f- - -- <br /> PACKAGE TREATMENT [ I SEPTIC •ANK Size J- -_---_------ Liquid Depth --- o'- --------------- <br /> �> <br /> _ Capacity -- - -------- Type -�RE�i,��-- Material- ------------------- No. Compartments ---- --------=•--- <br /> Distance to nearest: Well ------15 Q--/_--_---_--------Foundation ___/0_I---_-_-- Prop. Line .-_20------------- <br /> LEACHING <br /> ---..._--___LEACHING LINE [ ] No. of Lines ------9-------------- Length of each line-----J0,0--------------- Total Length ,. �------------ <br /> �a <br /> 'D' Box .. ------- Type Filter Material -P22 t.2A_Depth Filter Material -----1-# ------------------------------ <br /> Distance to nearest: Well ----i�o---_--------- Foundation __Ii'---_--- <br /> .-------- <br /> Property Line -_b-------_-------- <br /> SEEPAGE <br /> ------ --------SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---_----------------------- Rock Filled Yes ❑ No <br /> WaterTable Depth ---------------------------------------=--------Rock Size ---------------•---------------- <br /> Distance to nearest: Well --------`-------------------------------Foundation ------ Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------------..-__-_--__-._._----I <br /> Septic Tank (Specify Requirements) ------------------------------- --------------------------�--------------------------- _---------------------------- ' <br /> Disposal Field (Specify Requirements) 5 --------------•-------------------------------------------- ------;--------------------------------------------------------- i <br /> --------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------I------------------------ <br /> --------------I---- -------- ------------------ -----------.-:---------------------------------------------------------------------------------------------------------------------------- <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 /> 1.1 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 W rkman' Compensation laws of California." <br /> Signed ----------�--t -'------ '---`- -------------------------------------------------- <br /> _ Owner <br /> BY ----------------- -----------------------------•-----------------------------------.------------------ Title ---------------- ------------------------------------------------------- <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY . � --------------------------------------------------------------------- DATE -.----x: ` i <br /> BUILDING PERMIT ISSUED --------------------------------- <br /> DATE <br /> ------------- <br /> ADDITIONAL COMMENTS ...37{y 73 G PS_ _ lr .�= <br /> ./ ,_S <4- ------------------------------------------------------------------------------------------------- <br /> ' -------------------------------d---------------- ------------------------------------------------------------------------------------------------------------------------------'----- <br /> ------------------=- ----- ------- - ---- <br /> ----- <br /> Final Inspection by --------------------------- Date <br /> SAN JOAQUIN. LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />