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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> sl <br />.... ............ Permit No. ...�.....9 .. <br /> (Complete in Triplicate) <br />......................................................... 0:.��.7:� <br /> ..... .. <br /> .....I.............. .. This Permit Expires 1 Year From Date Issued bate Issued .1 <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/LOCATPte.@•_...� . .. , ....................CEN5US TRACT <br /> --.-.-.g....�-Z. _..-.-.-.-.-.-.-..- <br /> .............. . .....----:_....................Phone <br /> Owner's Name ...... City ......... ............... •---..........Address . [ . <br /> Contractor's Name ........ ........._... _. --- ..--........................License # . -x-1-3• _3. Phone <br /> Installation will serve: Residence ❑�Aptiartment House .Comm_ ercial ❑Troller Court <br /> f Motel ❑Other _.... ..._ .... -- { <br /> Number of living units:...... Number of bedrooms .._*) .Garbage Grinder ............ Lot Size ....----c6p.... •-•••-• <br /> Water Supply: Public System and name .................•-•.................-....................................... .................................Private <br /> Character of soil to a depth of 3 feet: sand 0 Silt E] - nCla Peat Sandy Loam 0 Clay Loam <br /> Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type ---'....................... , <br /> {Plot pian, 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 or seepage pit permitted if public sewer is available within 200 feet,) <br /> �r t / - <br /> PACKAGE TREATMENT [ ] SEPTIC TANK Y size---.7__..TS. ............................. Liquid Depth .�..�................. <br /> Capacity 1 Type i4A-44- ...... Material.&&kC-.ft___ .No. Compartments .. ...........:.. <br /> r / A. <br /> Distance to nearest: Well ........$_0.................•..Foundation ..._.t ............ Prop. Line 4 .....:........ <br /> LEACHING LINE No. of Lines ........ ....... Length of each line./00._ e...60. Total Length ............ <br /> -_I�?±D..� 0 <br /> 'D' <br /> pp it <br /> Box +� 4 .......... <br /> - I <br /> Type Filter Material ...Depth Filter Material ._.1.}� <br /> f � , <br /> Distance to nearest: Well .... �............. Foundation ----/Q.-"r..._..... Property Line 15....... <br /> SEEPAGE PIT [ } Depth Diameter ................ Number -----______-_----.-.._..:_ Rock Filled Yes ❑ No ❑rn <br /> • Water Table Depth *. 1." ............Rock Size ........................` <br /> a Distance-tii nearest: Well ----..............•.....................Foundation .................... Prop. Line .....................C <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ...................................••-...... <br /> ---- Date ....................:.... <br /> •....... <br /> t . <br /> Septic TankLS ecifReqvirements) -•--._...... `` `* ••••... ... . ) - <br /> CG <br /> Disposal Field (Specify Requirements) <br /> ........ .... . <br /> "i <br /> (Draw existing and requiredaddition 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 she work for which this permit is issued, i shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> r <br /> Signed Owner- ---------: --- -------------------------- -------- <br /> r <br /> By ..................�iiC�__.... .a...... ..........•-•--..............._....... Title ..._.._._. .. ' <br /> (if other n owner),'' FOR DEPARTMENT USE ONLY <br /> i APPLICATION ACCEPTED BY --- -- ................. DATE .... 0::—AP'.2-............. <br /> . <br /> BUILDINGPERMIT ISSUED -•.......................................................................••---•-•--......._.....-----.....DATE ... ....................................... <br /> ADDITIONALCOMMENTS .... --•....................................----•. -........---------•..._...............---------.....-•---.....------. ...... <br /> ...................................&­.......................•................. ............I.........................----•------....-.--..........., ...................... .�... <br /> ..............................................I......... ..........................---------............-•-•---- ...•._.............................................................. <br /> r ............................................... ........ ...............--•.... - .�_ ....._.... <br /> v Date <br /> f Final Ins e-ction b ... ......... ....A..:. ,... <br /> p Y: _.... ----------------. ...------------....... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 7172 3-M <br />