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FOR OFFICE USf: ���°"' <br /> APPLICATION `AOR UANITATION PERMIT � 1 <br /> -------R---------------- - ------------ <br /> ---- (Complete in Triplicate) Permit No. <br /> ----------------------------- --- ---------------------- <br /> --- ----- - ------- This Permit Expires i Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and instalf 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 ._ +sC��--- -- f- -- =-------- = --------------------CENSUS TRACT -----------------•-------- <br /> Owner's Name, 3� ------S Q A ` -------------Phone � -- -------- 1 <br /> Address - /0 - ----- ---------------------- City <br /> - -------------------------- <br /> Name '' - a`K->� _.. _. .. r ._.—_ � -®��p�____- <br /> - _ . - - License #,l6??. Phone <br /> Installation will serve: Residence ❑ Apatim"ent-House,E] Commercial.:❑Trailer Court 0 <br /> Motel ❑ Other°- ------------------- <br /> Number <br /> -- --- ----Number of living units: ___ ____ Number of 6edrooms ___ _:__Garbage Grinder_____:____!_ Lot Size __ - -lC_7-00_________________ <br /> Water Supply; Public System and name __ ____ ° Private ❑ <br /> -.=-------------------------------------------- <br /> Character of soil to a depth of 3 feet: Sandti+ �'Si[f❑ Clay ❑ Peat❑ Sandy Loam ❑ . Clay Loam :❑ <br /> Hardpan ❑\ 'Adobg,�Fill Material -------M---- If yes,type ---------------------------- <br /> k <br /> (Plot plan, showing size of lot, location of system in relation to wel[s, buildings; etc. must be placed on reverse side.) <br /> a <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is av6ilable within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'[ I Size------------------------------------------------ Liquid Depth -----------------.. <br /> Capacity -------------------- Type ---------------- - Material--------------------- No. Compartments ---•---------••••----- <br /> Distance to nearest: Well - ----------------------------------Foundation `--------------------- Prop. Line --------......-.------ <br /> LEACHING LINE [ ] No. of Lines ______________________ Length of-each=line---------------------------- Total Length -----------------------_-- <br /> 'D' <br /> ____--__._-_______---- .__'D' Box ------------ Type Filter Material --------------------Depth Filter-Material ----------..------------------_•---------... <br /> Distance to nearest: Well ----t-------------- '---------- Property Line ------------------•-•--- <br /> Foundation <br /> SEEPAGE PIT [ ] Depth ---_---____________ Diameter ---------------- Number ---------�__.____-.___-__--__ Rock Filled Yes ❑ No ❑• t <br /> Water Table Depth [ --------------------Rock Size -------------------------------- <br /> Distance <br /> ___________________________ _Distance to nearest: Well -----F---- i--------------Foundation '------------------ Prop. Line ------••-------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .................................. --,.Date ______--____________._ <br /> Septic Tank (Specify Requirements) ------------------------------------------------ ---------'-----------`---------=-- ---------------------------- /- <br /> Disposal Field (Specify Requirements) -__.- j --- pf--- / <br /> . ---------- ----- � t <br /> ------------- ----------- <br /> (Draw existing and required addition on reverse side) <br />' 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin 1' <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 become subject to Workman's Compensation laws of California." <br /> Signed ---------------------- - --------------------------------------------------------------- Owner " <br /> ------------------------------------------- -Title - -- a. <br /> other than owner) <br /> FOR .DEPARTMENT USE ONLY <br /> BUILDING PERMIT ISSUED -----------------------------------------------------------l-- � a -- - ---------- DApqT i-- --- ----- ---------------- -- <br /> APPLICATION ACCEPTED 8Y -" - _ .___ <br /> ADy -- - ----- --- --------------------- <br /> -------------------------- ------------------------- ----- <br /> L COIVMENTS_ ---------- ---------------------------------------- <br /> ------------- <br /> - <br /> /- ------- �- - - ------ --- �-�-----�--------------------------- ----------------------------------------------- <br /> ------------------------------------ ------- <br /> -------- ------------------=------- <br /> Final <br /> Inspection by: --------- - / �J;l ��.��e---------------------------------------------------------------Date -------- -------- <br /> -------------------------- <br /> 1Q JOAQ6IN LOCAL HEALTH DISTRICT <br /> V - } <br /> E. H. 9 1-'68 Rev. 5M G <br />