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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT ,/— <br /> 7. <br /> .Tr"... � <br /> IComplete in Triplicate) Permit No. . <br /> ..................................... ­ --------- <br /> ' <br /> _....._..... ----.. This Permit Expires 1 Year From Date Issued bate 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 ......jo ._.... _.•�:5--------- - ------- �'�G` ...----- . .....CENSUS TRACT ...................... <br /> Owner's Nome �. �} .. ---- ..................Phone <br /> ....... ........ .. ........... ..... <br /> Address f°ur �f =,i /z--- ------ -----. City -.. �`'...:-Af¢ �Fc.:'q.......... <br /> ..... <br /> Contractor's Name•...--, �.1.... U h --------------------------- . ----.License Phone <br /> installation will serve, =-Residence_{ Apartment-HouseG-Commercial-[]Traller-Court <br /> fMotei [-] Other .. = <br /> Number of living uni.ts:............. Number of bedrooms ........Garbage Grinder ._._.._... Lot Size /0.............................. <br /> Water Supply: Public System and name ----- ................`-------------.............................................. -----• -------------- Private <br /> Character of soil to a 'depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loom ❑ <br /> Hardpan ❑ Adobe E] Fill Material ............ If yes,type ........ .. ....!....- <br /> (Plot plan, showing size of of f;:`Iocat on of system in relation to wells, buildings,,etch must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is avoillablL within 200 feet,) <br /> I <br /> _7, <br /> PACKAGE TREATMENT [ ] SEPTIC TANK-[ j Size.....J� .. .k_.`.�._....1_... Liquid Depth .--_.�_..__.............. <br /> _ � <br /> _ ,� I t .. <br /> Capacity/ !! ? .----. Type p,E' .G!@ Material_......... ...... No. Compartments .-° .............. <br /> I Distance to nearest: Well . ._ .-..........................Foundation ...:-.-..i....- •----. Prop. Line ...................... <br /> LEACHING LINE { ] No. of Lines _.. .- .. Length of each line .....__.YO,-"..'...__ITotal�Length <br /> 'D' Box ... i f..- <br /> Type Filter Material .l�a'��__.bepth Filter Material :._.���.............----------------... <br /> F <br /> Distance to nearest: Well A�-�._.--.-.--- Foundation _..,5� ... Property Line _S..°_.�...._...... <br /> `SEEPAGE PIT [ ] Depth . . .. ......... Diameter ---------------- Number • :" . ... Rock Filled Yes ❑ No <br /> Water Table Depth _.. ••Rock Size I k <br /> Distance to nearest: Well ................................•__-�! Foun ion J tltl .----- _ _- Prop.! Line ...................... <br /> k REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------_...._._ Ddfe -----------.....l................. <br /> ) � <br /> Septic Tank (Specify Requirements) -- ..................................... ................... .. <br /> - - - ..................... .. <br /> Disposal Field (SpeC ify Requirements) ..- - ... ........ ) <br /> 7 --------------------------- ---- -} - ....... ..... .... _.. .................................-.___1 ....................................­ .........-------- ----•-•-- <br /> .... ....................... .----- �.. .� i .... ...................... .......r........ ---.- -----• <br /> (Draw existing and required additi$n on reverse side) <br /> I hereby certify that I have prepared this application and that th work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the �ari�}Joaquin Local Health District. Home owner or llcen- <br /> sed agents signature certifies the following: <br /> k "I certify that in the performance of the work for which this permit .)s 4sVed, I shall not employ any perion in such manner <br /> - -- ----------------------- Ove s <br /> as to become subject to W� man' omission laws of California.'' <br /> f Signederg <br /> i I i <br /> By . . . ... ....... .......... :...................................... ....... ..... .. ............... Title , . .. <br /> (if other than owner) <br /> I FOR DEPARTMENT USE ONLY <br /> DATE .. <br /> APPLICATION ACCEPTED BY ——.4� �� _ '.... .- .........- <br /> BUILDING PERMIT-ISSUED ----..•,.-'Q.P "-- - - DATE-.-- - ..._. <br /> .... ......._....ter- ... <br /> ADDITIONALCOMMENTS ....................._.......................................................---------------------- --------------------.-------------------------------------- <br /> -------------------------------------------------- --- ................... ------------------............... <br /> , <br /> ............. ----------- .......... - ----------- .......... ........... <br /> r - - <br /> Final Inspection by: ..... . -- ------------ -- .__Date ......_...-.- .....��. _ ... <br /> - --- --•.--------- <br /> SAN.JOAQUIN LOCAL HEALTH DISTRICT <br /> c v 13 24 1 -,&Q o_., ray -1/72'3 4 <br />