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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7e `2— + <br /> Permit No. _7e �.• <br /> ..........--------................................. (Complete in Triplicate) pate <br /> _ __ � issued <br /> ........................I.......I...... p <br /> _........ ........................ <br /> This Permit Expires 1i Year From Date issued <br /> it to construct and <br /> all the work herein <br /> Application is hereby mode itao the SS° compliance wiin Local Hh Cauealth nytOrdinance rict for a Nom549 and existing Rules tand Regulationst. <br /> described. This application mode <br /> . .. .....CENSUS TRACT .. ................... <br /> JOB ADDRESS/LOCATION .-/..�' S•- -•.% -. ......---�• j--�. . .._. <br /> e:� t ..._!l �Po ...................... <br /> Owne7,Name ....... <br /> Address'-..---- - .. .....'�.il ... City ..... +� ........... <br /> --- <br /> 4 License # .Y Phone ..............: .. <br /> Contractor's Name ...... <br /> Installation will serve: Residence Apartment House0 Commercial []Trailer Court tom] <br /> r <br /> Motel ❑Other _.:. .. .... <br /> Number of living units:.___.. Number of,bedrooms _..:rn-::• Garbage Grinder ........ Lot Size ..- <br /> ❑ <br /> L.. - - - •.............Private <br /> Water Supply: Public System,and name ........................... <br /> ❑ -. t El Cloy Cl ❑ Peat <br /> Character of soil to a depth of 3 feet: Sand Sil <br /> ❑ Sandy Loam Clay Loam [I <br /> Hardpan C] Adoli 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 aide.) <br /> blNEW INSTALLATION: (No septic tank,or seepage pit, permitted If public sewer is ae within 200#eet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK I ] <br /> Size................•--•--•----..... Liquid <br /> Depth ............................ <br /> Type".—".—...-••--•• <br /> Material-------------------- No. Compartments ................... . <br /> Capacity •------------------• Yp „ � e <br /> ... ., r.. .. Prop. Lin <br /> ,. nearest. Well ....................... Foundation ....... - ........._...... <br /> J <br /> 00 <br /> Distance ton _ Total ,Length .......•--•••---....... <br /> F <br /> LEACHING LINE No. of Lines . Length of:each line.................. <br /> D' Box Type Filter Material ..:...:.::..........Depth Filter Material s• ..........Line......... ..... -•••-• <br /> Foundation Property •.......•••-••. <br /> Distance to nearest: Well :......... ....... ... i j) <br /> Depth ._ Diameter Number .....:......:.........:..... .Rock Filled `Yes No <br /> SEEPAGE PIT { l ❑ <br /> "..._.....Rock Size " <br /> Water Table Depth ....................... <br /> Distance to nearest: Well <br /> ..Foundation -_ ... Prop. Line :..................... <br /> REPAIR/ADDITION Sanitation Permit 5 ......---•----..•• Date .___... ..............••••--•) <br /> (Prev.( ............. .................................. <br /> _ .. <br /> ! Septic Tank (Specify Requirements) ...:............. . ........................... <br /> 00.r+r <br /> Disposal Field (Specify Requirements) <br /> lam- �•:......X.. .la------ •-- --- ................ <br /> --......_--.. ............. . ........._....----......-•.. . .. .-----... ....__....:::.I-- .. ......I.._....... <br /> (Draw existing and required, addition on reverse side) <br /> 1 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 licwl- <br /> sed agents signature certifies the following: h, <br /> - <br /> "1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in suemanner <br /> as to become subject to Workman's Compensation laws of California." <br /> : - Owner.e <br /> r <br /> •Si red <br /> .. .. . ... .. ..... .. .........................Title <br /> (if other than owner) <br /> FOR DEPARTMENT DISE ONLY <br /> DATE <br /> APPLICATION ACCEPTED BY = ..................................... <br /> ice_ ..�..� .._.... <br /> BUILDING PERMIT ISSUED ... ..................I........--....DAT .. ---..--................. <br /> ... <br /> ... <br /> ....... <br /> ......................•.-......--•- <br /> ADDITIONAL COMMENTS ..ro,sem- ......_. •x .11 �..._.... ... <br /> ..... ...................................: _.. ... :....._... <br /> -- <br /> > ----- <br /> a 4:, <br /> FinalInspection by: . ...........................................-••..................................................Date-.... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 7/72 3 M <br />