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W- I <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> --- ------------------------------------------------ - - � <br /> , Permit No. - <br /> =__ <br /> (Complete in Triplicate) ti <br /> -- This Permit Expires 1 Year From Date Issued Date Issued- __F <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein <br /> described. This application is made in compliance with County Or 'nance No. 549 and existin E yI lations: <br /> 313X / J <br /> /�_CENSUS TRACT -------------- ----------- ' <br /> J08 ADDRESS/LOC T! N .---�"7_'.� - - --- --_-- �- - ----------- --�---------_---- -,- <br /> ---- --- --------------f <br /> Owner's Name ---------- -------Phone --------------------------------- <br /> Address -------- -- -. ------------� ------------------------- Cit �--- <br /> ---- <br /> - --------------------------- ----------------- y = --- ---------------------------------------------------------- <br /> Contractor's Name <br /> yl l Licens / d fes{ fr Phone /�1 l--J <br /> Installation will serve: Residence 0 Apartment House❑ Commercial.:Myrailer Court ;❑ <br /> '13 <br /> Motel ❑Other -------------------------------------------- <br /> Numbar of living units:----------- Number of ibedrooms ------------Garbage Grinder ------------ Lot Size -------------------------------------------- t <br /> Water Supply: Public System and name ------'------------------------------------------------------ -------------------------------------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sands'❑ Silt❑ Clay ❑ Peat❑; Sandy Loam •El Clay Loam ❑ <br /> l Hardpa 1 ❑ Adobe ❑ Fill Material ------------ If yes,type ------------------------- <br /> .(Plot plan, showing size,of lot, location ofr system in relation wells, buildings, etc. must be placed on reverse side.) <br /> NEW 1NSTALLATION: (No septic tank or seepage pit per 'tt if public sewer is available within 200 feet,) W <br /> PACKAGE TREATMENT { ] SEPTIC TANK:[ ] S ------------------------------------------------ Liquid Depth ------------------ <br /> Capacity -/' -� L' Type - -Z?A-- __?` t►laterial---------------------- No. Compartments ----------------•.-- <br /> Distance to nearest: Well ------------ -----------------------Foundation ---------------------- Prop. Line ----------f_:_------- <br /> LEACHING LINE [ ] No. of Lines ----------- ------------ }en of each line------- -------------- Total Length .-___f.�--------------- <br /> 'D' Box ------------ Type';Filter Mat ial -------—-----'f-Depth Fi) er Material ------------------------------- -----. <br /> Distance to nearest:i I ----- - -----__-_--- Foundation Property Line ________________________ <br /> [ 1 p Number <br /> Di' eter ---_� <br /> ---------------- Rock Filled Yes �] No <br /> SEEPAGE PLT Water Table Depth -. --- _-� - ,-[ - /------------------Roek Size --------- ---- <br /> ` --_ Distance to nearest: W I _ - r` -�!_ y--_-Foundation ------ Prop. Line -. _______________ <br /> REPAIR/ADDITION(Prey:Sanitation Permit# ------ -}"' ---/-- --__- Date ---------------------------------- <br /> Septic <br /> ---------------- --------Septic Tank (Specify Requirements) ^`��---------------------------------------------------------------------------------------------------,,.--------------------------- <br /> Disposal Field {Specify Requirements) --__-----_ "'" <br /> ---- ----------- - <br /> ----------------------- ------------------------------------------------------------- ------------------------ ---- ----------------------------------------------------------- <br /> .1 <br /> _----------------------------- --- <br /> --------------------------------------------------- --------------------------------------------------------` -- ---------------------------------- <br /> -- <br /> a(Drawexisting and required addition on reverse side) <br /> I hereby certify that 1 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: t <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 F <br /> as to become subject to Workman's Compensation laws of California." <br /> :f <br /> Signed ------------------------------------------------------------------------------------------------- Owner <br /> By ----------------------------------------------------------------------------------------------------- Title ----------------------------------- ------------------------- <br /> lif other than owner) ry <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _�i_-J- -- - ---- -- ------- - - ----------- DATE -. "- -- ----------- <br /> BUILDING PERMIT ISSUED ------- --- cam`--- ------------ ------------- -----DATE ------------------------------------------- ! <br /> -- f <br /> ADDITIONAL COMMENTS ----------------------------------- ------------------------ - ------------- --- ----- �� -III- <br /> ------------------------------------- <br /> - - -----------r___ ,___________�______-_ __ ____ -__ __._-___-------- ---- -_- <br /> ------------------------------- <br /> - I <br /> FinalInspe on by: ---------------------------------------------- -------------- Date _... ------------------------ <br /> SAN JOAQUIN LOCA[. HEALTH DISTRICT <br /> � E: H::;4 1-'68 Rev. 5M <br />