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=K <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ------------------------------------------------ Permit No. ----71a 7 <br /> (Complete in Triplicate) <br /> ---------=-------------------------------------- <br /> -------------- This Permit Expires 1 Year From Date Issued Date Issued __. _"_%` <br /> _ <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�Jcompliance <br /> , with County Ordinance No. 549 and Rules and Regulations: <br /> JOB ADDRESS/LOCAT ON . 7- N/-� -------- '�`-'+ CENSUS TRACT <br /> pp <br /> Owner's Name .---- - - ------------- `----------- 2 Phone <� = _Q.. <br /> �i�� - --- ----------------- ------------- -- <br /> Address __._.__ " <br /> —� City ------- --- --------------------------- r <br /> Contractor's Name ----- ---------------------------------------------License # ------------------------ Phone ------------------------------ <br /> Installation will serve: Residence XApartment House❑ Commercial ❑Trailer Court i❑ <br /> Motel ❑Other ------------------------------------------ <br /> Number of living units:----/ ---- Number of bedrooms ...Garbage Grinder _ Lot Size _____"-Pri <br /> ..______---- <br /> Water Supply: Public System and name ------------------------------ ------------------------------------------------------------------- r, <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam XX Clay Loam ❑ i <br /> Hardpan ❑ Adobe ❑ Fill Material ___________ If yes,type --------------- ------ a <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 Size_-15__X -__________________ Liquid Depth -V�>'-__-__,_____ <br /> 5 Capacity ��1�- ------ Type,-C--=---'rvlaterialdQ_(11 No. Compartments - -- -- ---------- <br /> Distance to nearest: Well ------r.5_0------------------Foundation _____________ Prop. Line --- -------------- <br /> �r t <br /> LEACHING LINE No. of Lines ----- ___________-Length of each line-----------ro-------- Total Length _______ <br /> f 'D' Box ------------ Type Filter Material --------------------Depth Filter Material -- ---------------------------- --------- <br /> Distance to nearest: Well ________________________ Foundation ------------------------ Property Line_ -._____-_____-_.___-____ <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No i❑ <br /> WaterTable Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------- ---- Prop. Line ----_---------------- <br /> J�: <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------------------_---------- Date _________________-..______________) <br /> Septic Tank (Specify Requirements) ------------------------------------------------- ------------- ---------------------------- _---------------- ------ <br /> Disposal Field {Specify Requirements] --------------------------------------------------------------------------------------------- -----------------------•--------------- <br /> -----------------------------------------------------------------=--------------------;------------------------------------------------------------------------------- -. <br /> ---------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------------- <br /> (Draw existing and required addition 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 the work for which this permit is issued, I shall not employ any person in such manner <br /> as to becomes je�ct tt Workman's//Compensa7��rxllwc <br /> la f California." <br /> Signed % C_,_1_ f� '1��� ----------- Owner <br /> BY --------- --------------------------------------------- ---------------------------------------------- Title ---------------I-------------------------------------------------------- <br /> (If other than owner) <br /> lon7 F R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY '- ----- ------------------------------------------------- DATE ---- /---7,-->7 --------- <br /> BUILDINGPERMIT ISSUED -------------------- ------------------------------------------------------------------------------------DATE ------------------------------------------- <br /> ADDITIONAL COMMENTS ------------------------- ----------------------------------------- ------------------------------------- ------------=--------------------------- <br /> - ------------ <br /> ----------------------------------------------------------------- --- ---------------------------------------------------------------- <br /> ------------------------------------------------------------ ------------ ------- -------° ------ <br /> Final Inspection by: t=� �--- --------- <br /> _ ---------------------------------------------- -- --------- Date <br /> Kt <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> F- M_ 9 1-'68 Rev- 5M <br />