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FOR OFFICE USE <br /> 2 ,13-4 6111 APPLICATION FOR SANITATION PERMIT <br /> (Complete in Trlplicatel <br /> - <br /> ,.... w...... v. ..:,... .'..Mme.. <br /> 1 Date Issued . <br /> ...... ......................... ,/.1..---.... This Permit Expires t Year From Daft Inuod <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herei <br /> described. This application is made in compliance wit County Ordinancq No. 549 and existingRules and Regula <br /> T- (! ti s: <br /> ' ioLCCA c-{E- ST. "7Q <br /> JOB ADDRESS/LOCATION § <br /> D... . . -j CENSUS T CT .- <br /> Owner's Name ' ..- c................ .........�,........................ <br /> .................... . one <br /> Address iy <br /> .......1L1 .1[f.. 1 ......... <br /> .. <br /> Contractor's Name _...... .. G. -- - ----- .......-...........................License #l.,3,3 ,1 ... Phone PMV. ... ... <br /> Installation will serve: Residence Q Apartment House E] Commercial QTrailer Court C] <br /> Motel❑Other ............................................ _ <br /> Number of living units:-,_..... Number of bedrooms .....2...Garbage Grinder ..,......... Lot Size . � ................... <br /> Water Supply: Public System and name ..........................................................•....•--............................................Private❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt Q Clay ❑ Peat[ Sandy Loom 0 Clay Loam,( <br /> Hardpan❑ Adobe'Q Fill Materlol ............if yes,type........... ............ r <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 Jp available within 200 foot,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK I ] Size.--! ,.r -� ._...•............. Liquid Depth .4...�............. <br /> Capacity ./.94U9.. Type . Zter <br /> ial._.�r�' ........ No. Compartments ............ <br /> Distance to nearest: Well .. ,. ........Foundation .`.�............... Prop. Line ....1�1 .... <br /> LEACHING LINE [ J No. of Lines ................... Length of each line::/r/ ,5-j Total Length ...J ---C ..... <br /> 'D' Box .._ Type Filter Material .... ... ..Depth Filter Material .., ... ................................. <br /> Distance to neare t; Well ........................ Foundation ........................ Property Line ..... .................. <br /> SEEPAGE PIT E ) Depth ` ' �- Diameter <br /> Number ............................ Rock Filled YesA No 0 <br /> Water Table Depth __._.•..__._...-•••................••-•-•----...Rock Size ................................ <br /> Distance to nearest: Well ........................................Foundation _.•_...._... ....... Prop. Line ...................... <br /> REPAIR/ADDITION!Prov. 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 wilt be done In accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Hunte owner or lice• <br /> sed agents signature certifles the following: <br /> "I certify that in the performance of the work for which this permit Is issued, I sholl not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed .............:. ------------------- ------- Owner <br /> BY .................. Title _.. ------- _ ---------- -------- ................. <br /> �her�owner <br /> FOR DEPAILTMJINTUE ONLY <br /> .............. - <br /> APPLICATION ACCEPTED BY - DATE . .. -..-. <br /> BUILDING PERMIT ISSUED_.. 1.._._- _ ._.._. ,.--__.DATE . ...- <br /> ADDITIONAL COMMENTS --- .. ................•...._..._._..._.. - ...._.:. <br /> - -- ,�`� <br /> Final tnspectionbY <br /> ............... ✓.... ':.._Date . - .. .......... <br /> ,/�z.f -_ <br /> EI 13 24 1-68 Rev. c iSAN JOAQUIN L ,1� <br /> OCAL NEW, DISTRICT /71t 3M <br />