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FOR OFFICE USE: <br /> 1.3v E APPLICATION FOR SANITATION PERMIT -- <br /> - �� _ Permit No. -_7 _ 70a <br /> (Complete in Triplicate) <br /> ---- <br /> ---------=---------------------------------------------- <br /> ___________________________ This permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein <br /> described. This application is made in compliance with Count Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .----- ©- -------4�-•_____. --1 ----- ------ ----CENSUS TRACT -------------------------- <br /> Owner's Name -------------------- �.- Phone <br /> Address --------- -------------------------------------------------------------------- City ---- 1._F__C� *7--------------------------------- <br /> Contractor's Name ------- Q7/--------_-------------------------License #lg - - PhoneE -2,69'/4a';, <br /> Installation will serve: Residencee10 Apartment House❑ Commercial []Trailer Court i❑ <br /> Motel ❑Other -------------------------------------------- <br /> Number of living units:---/------ Number of bedrooms _ -------Garbage Grinder eva-_ Lot Size --4a_d7__ ___/.2Q_--________ <br /> Water Supply: Public System and name ---G g?' r-_----107,----- -F� -----------------------------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'o Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe 9��ill 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 /> V <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK f ] Size------------------------------------------------ Liquid Depth -------------------------- <br /> Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ------ --------I...... <br /> Distance to nearest: Well ------------------------------------foundation ---------------------- 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 0 <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) ------------------ - ---- <br /> -------- - --------- <br /> e y <br /> Disposal Field (Specify Requirements) ------ loo -_________ <br /> ac, ��. lL� _� .►' � ----------------------------------------------- -------------------- ------------------------------------- <br /> ------------------------ - ------------------------------------------------------ ------------------------------------------------------------------------- ------ <br /> (Draw existing and required addition on reverse side). <br /> I hereby certify that 1 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 become subject to Workman's Compr,sation laws of California." <br /> Signed ------------ ----- <br /> ----------- ----------- - --- ----------------. Owner <br /> ----------------- <br /> By --- ------ --- °----------------------------- Title iLr <br /> -- -------------------------------------------- <br /> ilf r than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED By - <br /> �----------------------------------------------- ----------------------._------------------------------------------------------------------ DATE ...... <br /> -- �-n-f-�v-- �--0-------------- <br /> BUILDING PERMIT ISSUED --- - -- <br /> --------------- - DATE ------------_---------------_ <br /> ------- - - -------------- <br /> ADDITIONALCOMMENTS ------ --------------------------------------------------------------------------------------------------------------------------- --------------------------- <br /> ------------ ------------------------------------- --------------------------------------------------------------------------------------------- --------------------------------------------------------- <br /> --------------- - -- --------------------------------------------------------------------- ---- ------------------------------------ ----------------------------- <br /> ----- ---------------------- ----- <br /> ---=------- <br /> -----Date -------------------------- -Final Inspection by: - - SAN- <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M <br />