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t <br /> FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ---- Permit <br /> n�Triplicatel <br /> ----------------------------- -------- ------------------ <br /> (Complete iDate Issued... _-l-. '�� <br /> _- <br /> -------------------------- - ------ This Permit Expires 1 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 described. <br /> This application is made in compliance with County OpLddinancA No 549 and-existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION..... .® ------ - - - -- ----- ------ ---- CENSUS TRACT,• - <br /> I ° <br /> Owner's Name :Phon -- ---4- <br /> ;_-------------------------- <br /> Address Q- ------------ ----- --- -City ZAP <br /> ---: ---- - -- - <br /> --- -- -- <br /> Cointractor's Name - -License #..-._zt44Z Phone- ' <br /> installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other--------.-----------------------------`------- <br /> ; <br /> Number of living units-------------...Number of bedrooms--- 3-Garbage Grinde --------....lot Size--------------------------- - ----- ------------- -------- <br /> Water Supply: Public System and name. -------------- --- ------------------------ -----------:--_'-------------------7.- -------------------Private <br /> r <br /> Character of soil to a depth of 3 feet: ' Sand ❑ s, Silt El Clay E:1 Peat El Sandy Loam ❑ Clay Loam Eli Hardpan = Adobe Q Fill Material=...`- It yes,'type___ ------- ------------------ <br /> (Plot <br /> -t--------------(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 for seepage pit permitted if public sewer is available within 200 feet,} <br /> PACKAGE TREATMENT A ] ' SEPTIC TAMC [ ] Size`--------------------------------------------- <br /> 'Type , <br /> ---------------------- ` --- - Liquid Depth----------------------'---- <br /> Ca acit _ -` ''_TYPe = = ::-°_Material- ---=_ =='- �"No`-"Compartments------- ---------------------i, <br /> I ------- <br /> Distance to nearest: Well, --- -------- '=-__-,'!==--"'Foundation----- ".,_._.---------------Prop. Line----=- -------- --- <br /> LEACHING LINE [ ] No. of Lines._ - : ,,_.Length of•each.I-ina---.. --- <br /> Total Lengthy- ,--:----- ' <br /> 'D' Box...... Type Filter Material .--- - Depth Filfer Material ' <br /> ', ------ -- <br /> f,. .. <br /> -Distance.to nearest:Well. ----- --....ltoundation-- _ Property Line-.__ <br /> ON <br /> F .= SEEPAGE PIT [ ] Depth....:------------D�iamet@r f;-----------Number---------------------------------- ; Rock'Filled.,Yes ❑ No Dy <br /> c .« R - <br /> Water Table:Dep � -- --------------- ---- =-- --- Rock Size <br /> I! � --- -- - k - <br /> PrevDSanaitation'Permit#Well_-.-,� =-'...Foundation________ ____________'_-Prop. Line <br /> [ r . + ------------ -7 <br /> REPAIR/ADDITION ( J _ = Date----�_°'.r,�- <br /> Septic Tank (Specify Requirements) +.. �-= - _---------- ----: I <br /> e <br /> 9Y-- ---- - ----- --- <br /> Disposal Field (Specify Re uilramentts).---- :-_---- =- '. <br />