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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT �i <br /> --------------------------------------------------------- � Permit No. <br /> (Complete in Triplicate) <br /> -------------------- ------------ This Permit Expires 1 Year From Date Issued <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for ad 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 _---7 --�.----,_F-------��0-d3 -- ------------------CENSUS TRACT _s{,t{- ---.------ <br /> Owner's Name ..-1-,. �7 -----------------Phone <br /> Address -------- -----C-+!-c'° -----= � ----------. CitY ''?'` <br /> Contractor's Name _ __' 4-_-___ 41icense# _)_ c3_ -Phone ------------------_---------- <br /> Installation will serve: Residench Apartment House❑ Commercial ❑Trailer Court 0 <br /> Motel ❑Other ------------------------------------------ <br /> Number of living units:------ ---- Number of bedrooms ----7"--Garbage Grinder ---------- Lot Size <br /> Water Supply: Public System and name ---------------------------------------------------------------y-----------------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 21.1"Clay Loam;❑ <br /> Hardpan ❑ Adobe ❑ Fill Material _----------- If yes,type ---------------------------- <br /> (Plot <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: (j septic tank or seepage it permitted u� ewer is available within 200 feet,) <br /> P P 9 P� P f P� � e <br /> PACKAGE TREATMENT SEPTIC TANK' Size_ _ <br /> - - �---�`��--•-.-�--- --- Liquid .Depth -- ------------------.----- � <br /> Capacity {{ n 1*__- Materi _7__ No. Compartments -_- -.- <br /> P Y -i_r�ab-�e--� Tyle --------------- ---- P �:-------- <br /> Distance to nearest: Well ______-_ "�__O__l---------------Foundation ------ ------- Prop. Line ___-'�'�.-_ <br /> LEACHING LINE [I( No. of Lines -----------r..---------- Length of+each line________g0_/_____ Total Length ----Awlr.............. <br /> �� <br /> 'D' Box -- ---- <br /> Type Filter Material -----Depth Filter Material -------l�________________®............. <br /> Distance t nearest: Well --------�0_.1_____- Foundation.-------- V---/--------- Property Line 5.................. <br /> SEEPAGE PIT [ j Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 0 <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well __-------------------------------------Foundation -------------------- Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ___---_.----_----_----------.._---) <br /> SepticTank (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 become subject to Wo man's Compensation laws of California." <br /> Signed ---------------------------- fj ----•-•------------- Owner <br /> BY --------------------- -------------- -C'----� 2 ----------- Title - - - <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY •`�'� ---------------------------------------- ---------------- DATE -----`--- -?J--�- <br /> ------------------ <br /> BUILDING PERMIT ISSUED --- -------------------------------------------------------------------------DATE ----------------------------- <br /> ----------- <br /> ADDITIONALCOMMENTS --------------------------------------------------------------- --------------------------------------------------------- --------------------------- <br /> -------------- ------------------- <br /> --------- ----------------------------------- --- -------- '' --/ B / .-----ow----- -",.-4,f__-;'j------------------------------------------------------- ------ ----------- <br /> . . + <br /> ---------------------------------- -- -- -- ---- <br /> ------------------------------------------------------------------------------------------------------------------------------------- - <br /> ----- <br /> ------------- <br /> ----------------------------- ----------- <br /> ---- -- - -- <br /> -----------------------------------------------------------------------Date ---!77-/----a- --------- <br /> Final Inspection by: <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />