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FOR OFF.ICt'USE: _ ---. <br /> " IPPLICATION FOR SANITATION PE S. � <br /> ------- (Complete in Triplicate) er t o: 71_1Qv`� <br /> __ This permit Expires 1 Year From Date Issued at ; <br /> e Issued __? V <br /> � r <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install he ,o k hese <br /> described. This application is mad in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ,4DDRE5S/LOCATIO1 -- s <br /> _ -•��-�^ � r�,-r-°-�..����_�_�-�--�'`------^ :�-- - -- (r� <br /> � <br /> �� <br /> S TRACT_�- ---- _. <br /> ------------ - - -Owner's Name / - ----Phone <br /> -. <br /> Address , <br /> -- 1. 1 �C- 4 -------------------- -------- Cit 1'"rt <br /> - - ----- •-----•-----•----- <br /> Contractor's Name.__ .fie- R Iea_ '_c "�_.,. <br /> ' License # 4-` Phone <br /> Installation will serve: Residence []Apartment House❑)}Commercial ❑Trailer Court ;❑ <br /> Motel E]Other, e„ ' '^ �! ” <br /> Number of living units:____- Number of bedrooms ---------_-.Garbage Grinder ------------ Lot Size <br /> Water Supply: Public System and name ------------------------------------_-_ <br /> -_------- ----------- ----•-----•-----•-- - - -------Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt:❑ Clay ❑ Peat Ej Sandy Loam .0 Clay Loam 'o <br /> Hardpan ❑ Adobe .0 Fill Material ------------ If yes, t <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) h <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,J <br /> PACKAGE TREATMENT j ] SEPTIC TANK' a <br /> [ 7 Size----------------------------------- -- ------ Liquid Depth ------------------ <br /> Capacity -------------------- Type -------------------- Material-------------------- - No. Compartments ---------------_----- S <br /> Distance to nearest: Well ------------------------ - <br /> ----------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 /> Depth ---- <br /> SEEPAGE PIT _ Diameter ____________ ___ Number ____.__._---_________-_--- Rock Filled Yes E] No 0[ 1 =------ -- -- <br /> Water Table Depth ------------------- ----- -------Rock Size <br /> Distance to nearest: Well ---------------•------------------------Foundation -------------------- Prop. Line ---------­---------- <br /> ------ <br /> -•------••--__------ <br /> REPAIR/ADbITION(P .v. Sanitation Permit# __ -- T_t---_- - - Date ___ <br /> an pecify Requirements} _---- <br /> ----------------------------------------------------- <br /> Disposal Field (Specify Re ui ements) ---------------------------- <br /> ----------------------------------- ----------------- --------- ----- <br /> r ti� _� ------------------ <br /> R n ,! <br /> (Draw existing and required addn reverse siEle) <br /> ------ ---- ------ --- <br /> I hereby certify that I have preparei jo ,o <br /> d 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, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ------------------------- --------•- Owner <br /> ------------ ------ - <br /> BY --- ----------------------------------------------- Title --------- ------ <br /> - ------------------------------- <br /> (lf other than owner) -------------------------------------------------------- <br /> FOR <br /> ------ ----------- ---------- ------------- ------- <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY____--- --- <br /> .__ -.. <br /> -------------------------------------------------------. DATE --- <br /> BUILDING PERMIT ISSUED - - '-; i <br /> ADDITIONAL COMMENTS .----Y-=-- =? DATE - <br /> ----------------------------------------••---- <br /> -------------------------- ---------------------------------------------------------------------------------------- ------------I--------------------------------------------------------------------- <br /> --- - - --- -- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> Final Inspection by: _______________ <br /> -------- --------- -- ------------ -- ---- -----•---- ---------- ----------Date ---- ----- ----- <br /> ---------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />