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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ........................................................... I�� Permit No. . <br /> ti, IlComplete In Triplicate) <br /> -------------I........................ 7 S <br /> Date Issued ...... <br />.................. ......................... ............... This Permit Expires I Yom From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> describecl.�Thls application Is madii In compliance with County Ordinance No. 549 and existing Rules and Regulationst. <br /> 'JOB ADDRESS/LOCATION .... ......... ................. ......... .....CENSUS TRACT ....................... <br /> Owner's Nome . ................__.....................I Phone <br /> .................................. <br /> Address ...3 ............................ City <br /> Phone <br /> Contractor's Nome- il!:.: -------.License #.�717 _ V <br /> Installation will serve: Residence A/partment Hous i e' 0 Commercial OTrailer Court 0 <br /> L <br /> Motel 0 Other_---•-••--•---•----------------------------- <br /> Number <br /> ---__------------------------------------ <br /> Number of living units.------------- Number of bedrooms ............Garbage Grinder --------- Lot Size .-----..---. <br /> Water Supply: Public System and name ................. ---­------------------ .................................................. .................Private 0 <br /> Character of soil to a depth of 3 feet: Sando Silto Clayo Peat Sandy Loam o Clay Loam o <br /> Hardpan E] Adobe 0 Fill 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 /> NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK I Size._...................... ................� Liquid Depth 2............ <br /> )a 00 Type -.----.----------...- +'Capacity - ----------- ----- _*_71,�--- Material..--------------------- No. Compartments- <br /> Distance to nearest. Well .....................................FoundationFoundation ...................... Prop. Line ....................... <br /> LEACHING LINENo. of Lines ------- <br /> ----------- Length of each line.,.9%0----------------- Total Length ..Zilro...I <br /> 'D' Box ....Y..... Type Filter Ma'terial �0 �epth Filter Material ................... .........................V) <br /> . <br /> Distance to nearest. Well ---•-------------------- foundation .......... ............. Property Line ........................ <br /> SEEPAGE PIT Depth _ ................. Diameter ................ Number ............--•--- ....... Rock Filled. Yes0 No � <br /> Water Table Depth .------•----•--•------------ Rock Size _.---- -------------------- <br /> Distance to nearest: Well .Foundation -- ............. _ <br /> ------ -------- ---- Prop. Line ....... --- -------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit ............ ---------------- ­­--­ Date -----_-__------_----_ <br /> Septic Tank (Specify Requirements) .................................... <br /> .....-•=--•--••---•---•---......---........._ :--------­I................................. <br /> Disposal Field (Specify'Requirements) ........:.................................. ............................................................ -------------------- <br /> ­----------------- ------- ---------------- -------------------------------------------------------------------------------------------------------------- ------------------------------- <br /> -------------------------------------------------------------­-----­------------_•_--_-•---------------- ........11-----------------------------------------------_..........­............... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 11 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 Son Joaquin Local Health District. Home owner or liven- <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 Compensation laws of California." <br /> Signed 4 ------------------ Owner <br /> By <br /> --------------------------- ----------- <br /> _cor------ ---- ----- .. ............� <br /> (if other than owner) <br /> A <br /> FOR DEPARTMENT USE 2MLY <br /> APPLICATION ACCEPTED BY ------- -- --- ---------- --------- ----------I---------------------- DATE - --7- ------ ---------- --- ------ <br /> -_ --.' ---- -------------- <br /> BUILDING PERMIT ISSUED ------------- ----- --------.. ------------ --------------------------DATE <br /> ADDITIONALCOMMENTS --------------------------------------------------------------- _---_----------•------....-..------•---•---------------...---------=------•---...--•--•-----........... ------------------------------------------------------------ ................ ............. ......­­­........................... ............ <br /> --------------------------------------------- ­ =------- ----- - - - --------------------------------------- <br /> // ------ - 91- .......... ...... <br /> ..21 - -­I ........... . . .. . ..... ....... <br /> --------------------------- . ....... . .... .... . .. <br /> ------------ <br /> ,Final Inspection by. ........ . . <br /> ...... .........Date <br /> ----------- <br /> EH 13 2h 1-68 Rev. 5M SAN JOAQUIN LO HEALTH DISTRICT 8/74 <br />