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r FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 3 <br /> -------- ----------------------------------------------- <br /> (Complete in Triplicate) Permit No. <br /> ---------------------------------------------------------- <br /> -------------------------._--___._.______-------........ This Permit Expires 1 Year From Date Issued <br /> Dote Issued <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. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION _ __. - ___ __ __ - .±._CENSUS TRACT -------------------------- <br /> Owner's <br /> _________________ __ _Owner's Name -- - � 7 -------=--777-- -------Phone.���'3rp----- <br /> -°' <br /> Address • ----------------- City ------ -- =- <br /> Cgontractor's Na a _-- -,r .�✓ -- - ---- ---- ----- � _.License # -------. -_-_.--- Phone 7S-_6_w 47 <br /> 337 __ <br /> �fhy serve. ' �e idcQe] Apartment House ❑ Commercial ❑Trailer Court i(] <br /> �, � � Motel ❑ Other -------------------------------------------- <br /> Number of <br /> -------------------------NNur-of living units.-.1------ Number of bedrooms _______Garbage Grinder -------- --- Lot Size -----14*^--------------------- <br /> a <br /> Water Supply: Public System and name .--------------------------------•-----------------------------------------------------•---------------------Private <br /> ] <br /> Character of soil to a depth of 3 feet: Sand'0 Silt E] Clay .Q Peat Q Sandy Loam ❑ Clay Loam jV <br /> Hardpan jr] Adobe '❑ Fill Material ------------ If yes, type ---------------------------- <br /> (Plot plan, showing size of lot, location of system inrelationto wells, buildings, etc. must be placed on reverse side.) <br /> i <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ! <br /> PACKAGE TREATMENT [ ] SEPTIC TANK;] Size_ "'i�_.'�'_�'_ 3-_____________________ Liquid Depth r------------------ Old <br /> Capacity—IS-00 x_.__ Type ____ Foundation - -,CC�'_r-_---_---_ Prop. Line ......_.Material��_ �' <br /> No. Compartments - _______________ <br /> - .... -' .\ <br /> Distance to nearest: Well ___��________________________ _ Vt <br /> LEACHING LINE [ No, of Lines _____________________ Length ofeachline.___-'__-._ ----- Total Length 1-Y10.1............ <br /> 'D' BoxA, Type Filter Material _ __i _______Depth Filter Material ___11 ------------------------------- <br /> Distance to nearest: Well --------- Foundation -- t3- -------- - Property Line. _-- ----_-f'_-_-___ <br /> SEEPAGE PIT -] Depth __ 47'_____ Diameter ✓ - ____-- Number -------I-�---------------- Rock Filled Yes '0 No i❑ <br /> n ----- a <br /> Water Table Depth ----/�----------------------------------Rock Size -.�,.�-- -�--------_--_-- <br /> --------------------------Foundation -- t� p• �r•`It----------- <br /> Distance to nearest: Well ___,lam__ �`______ Pro Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------.------_-..--.---...._...) <br /> t <br /> Septic Tank (Specify Requirements) -------------------- -------------------------------- --- ------ <br /> Disposal Field (Specify Requirements) -------------- ------- •---- --- --------------------------------------------------------•--------------- <br /> ­---------------------- <br /> s, <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 /> "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 beco .e{aubject to Work <br /> ma Compensation laws of California." i <br /> Signed -1 - ----�,..:� �--- -G�---�� �-. -�- -�"--� �----------- Owner I <br /> By ---------------------------------------- --------------------------- Title --------- ----------- - <br /> (If other than owner) ) <br /> FOR .DEPARTMENT USE ONLY � <br /> I <br /> APPLICATION ACCEPTED BY ---------------------------------------------------- ---------- DATE :. _ . _ -------- --- I <br /> BUILDING PERMIT ISSUEDATE -- ----- ---------------------------------- <br /> ADDITIONAL, COMMENTS �' = __---- '--------------------------------------------- --- <br /> - - i <br /> ------------ ------------------- ------------------------- - <br /> -------- ----- <br /> Fin, <br /> --- j _ _ __. <br /> - ------, __ r --mxGr _- - f_ - , <br /> -------------.Date _-------------------------- - - ----- <br /> - --- - ----------- - <br /> FinInspection bYi'----------------------- ---------------------------------------------------------------- - g <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 70 <br /> I <br /> E. H. 9 1-'68 Rev. 5M <br />