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FOR OFFICE USE: - <br /> APPLICATION FOR SANITATION PERMIT <br /> --------- --------------------------- Permit No. 7 '6 6 <br /> ------------------- <br /> (Complete in Triplicate) <br /> __-__.__--_______-------------- This Permit Expires 1 Year From Date Issued Date Issued _�1�7 . <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. 5.49 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCAT N .__ w _ _.-_CENSUS TRACT ________________________- <br /> Owner's Name ---li ��---- -- ----- ------ ------------- --- -- -� ---- -------------------Phone ------------------•----------------- <br /> Address �/---- :__ city <br /> 4J ��-tel` <br /> Contractor's Name ____ __ _ ______ _ _____________License i Phone <br /> Installation will serve: Residence [] Apartment HouseQ Commerci ❑Trailer Court ;❑ <br /> Motel ❑ Other _ <br /> Number of living units:----- --- Number of bedrooms ------Garbage Grinder ------------ Lot Size ----��Q. <br /> Water Supply: Public System and name ------------------------------ ---- ----------------------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam Q <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,) <br /> PACKAGE TREATMENT ( I SEPTIC TANK f ] Sipze_____T____-,l.//s� —----------------- Liquid Depth <br /> Capacity 1d11v_ ---- Type _ l�d-'- Material_L"YU-a— No. Compartments ------------- <br /> Distance � <br /> to nes est: Well __a ______- f-----__--__Foundation _X�------------- Prop. Line __ <br /> LEACHING LINE [ ] No. of Lines ________________________ Length of each line---------------------.------ Total Length __--__--_-___________.._-. - <br /> 'D' Box ------- Type Filter Material -------------------Depth Filter Material --------------------.----------.----------.- <br /> Distance to nearest: Well ________________________ Foundation ------------------------ Property Line --------------- ........ <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No I❑ <br /> Water Table Depth ------------------------------------------------Rock Size ---------------------------••--- <br /> Distance to nearest: Well ----------------------------------------Foundation ------------------ Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date --------------....__--____________) <br /> Septic Tank (Specify Requirements) --------- ----------- �---Q----�----`------------------------ -----------•---------- <br /> "`' <br /> Disposal Field (Specify Requirements) _ _ ----------G. -____� - / �1 � <br /> ------ � �� Je - Fre <br /> f <br /> 1.2 <br /> ---- - -- - �' ---- - --- -h-c - --- - - -------- -------,/�Tr <br /> ---------------- <br /> ( w existing and r uired addition on r rse side) <br /> 1 hereby certify that I have prepared this application and that the work will be done in accorith 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 become subject to Workman's Compensation laws of California." <br /> Signed g - -- --- - <br /> --- -- -------- ---- --------------------------- ------- - Owner <br /> ------------------------------------- <br /> BY -� ------ Title <br /> (if other tha wner) <br /> p FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY T - ---------- DATE ---a . <br /> BUILDING PERMIT ISSUED ------------ --- ------------ -- -----------DATE -------------- ------------------- <br /> ADDITIONAL, COMMENTS ------------- -------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> --------------------- <br /> - - ------- ---- <br /> Final-Inspection by: -------------------------------- ------------------------------------ ----------Date --ca�- /--- -- -------------------- <br /> SAN JOAQUIN LOCAL HEAL:'THISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />