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i <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. .�.:��`S.L�. <br /> ............ ......... —..................--- (Complete in Triplicate) <br />......................................................... Date Issued ..6'a•�:7 3 <br /> .............•.............. This Permit Expires ] Year From Date Issued -9(fo— 3Zo-07 <br /> Application is hereby made to the San Joaquin local Health District for a 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 /> (_A..P �9nv-'_-+ ..... <br /> JOB,.ADDRESS/LOCAT � .-_ _sa'��C� ...... '"'- . �'� C TRACT <br /> .� _ <br /> Owner's Name ........ .................................Phone7 .. ............ <br /> Address -- , C --•......... .. . City -- •- <br /> Contractor's Name ......... ............ .. . <br /> ..._ Ldt . -*--c.'......License # .2. -1•.'.3.-5�3 Phone <br /> Installation will serve: Residence Apartment House 0 Commercial ❑Trailer Court Q <br /> Motel ❑Other ..................................•.......-- <br /> J . <br /> Number of living units:____.I..... Number of bedrooms _-_. ...Garbage Grinder -----------. Lot Size ..._............- --• •--�-- <br /> ...... ....... <br /> Water Supply: Public System and name ----------------•-.. ...--------• ..........-._..--- ---------........------.........--- Private <br /> Character of soil to a depth of 3 feet: Sand [ Silt j]. :-Cloy_E]_P-egt-[D Sandy Loom ❑ Clay Loam Q <br /> Hardpan ❑ Adobe Q� 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) tr <br /> PACKAGE TREATMENT ( ] SEPTIC TANK ize ----_----------------: Liquid Depth ... ............... - <br /> Capacity ISM_ ._. Type No. Compartments .... ......... <br /> Distance to nearest: Well �Q..�. - _......Foundation <br /> ..1�.r......___.. Prop. Line .. .._.____..-••-_. <br /> LEACHING LINE No. of Lines ....... -—------ Length of each line.__;_.f._(�Q..�....-_---- Total length .... O.... ....... <br /> D' Box - Depth Filter Material `� <br /> -� -Type.,Filter Material�..9�!?�c�.-..:. ---•J�Q-•-............................--• �� <br /> Distance to nearest: Well'.'... � ..'._ Foundation _..f�_� Property Line ... ................... <br /> .2-- <br /> SEEPAGE PIT [ ) Depth -_- _0......... Diameter ....Number ............................ Rock Filled Yes No Q <br />` DRi IV �.jGfx..�s Water Table Depth ..� k Size j12� . 1 . ••-••' <br /> ........-- ...._....... <br /> Distance to nearest: Well ....:__.l�............... Foundation I <br /> r <br /> - ••------ ndation ....��---f--... Prop. Line ------•............... <br /> Iy <br /> REPAIR/ADDITION(Prev. Sanitation Permit'#,----••.•..--•--• --.... Date ..................................I , <br /> Septic Tank (Specify Requirements) ........­.-------••.............•---------•------.......--------............I.---------.........------ --•-•--- <br /> DisposalField (Specify Requirements) ... ----•-•....................'.--------........-----------....----•--•------....._....-------•---------••. .............. •-•-•----- <br /> #............................. -----------------------------------------------__---------------__ <br /> ....,....--•...............................................-----------------------.-----...---------'........_---.......................................-•--...._...-----------:.......I----------........ <br /> ; <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have preparecllhis 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 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 .,........ ....I......::........ Owner <br /> BYTitle ..'................................... <br /> (if othe n owner) _ <br /> SFO DEPARTMENT USE ONLY <br /> APPLICATION ACCE TED BY ...._. ...�.. . .............................._..----•----....... DATE ._... •-• .` _. ......... <br /> BUILDING PERMIT ISSUED �. ........-- DATE <br /> ..._....------ _.-•---- ......_•.... `•- <br /> ADDITIONALCOMMENTS ..........................................-- •............_.-• ------------------•-•-----------•-..........•-------•...... ....................... <br /> ..................-•.................. ..........7....................... ------....-......_...--------........------........:...-...------•----.....----.............._----- <br /> ...................................................• --•--------. .. <br /> ..... ate ..Final Inspection by. ................. L <br /> SAN.JOAQUIN LOCAL HEALTH DISTRICT , <br /> 7/72 <br />