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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No- -----10------- <br /> -------------- -- ----------------------- (Complete in Triplicate) t ' '" Date issued <br /> This Perm"it Expires 1 Year From Date Is ued <br /> suea <br /> k herein <br /> Application is hereby made to the San Joaquin Local Health District for a, permit to construct and install the wor <br /> described. This application is made in compliance with County Ordinance No. 549 and'existing Rules and Rogulations: <br /> JOB ADDRESS/LOCATION oo��__Ax ew_��------------------ ------------------------------------CENSUS TRACT .... -------- <br /> Owner's Name ---- -----------------_--------------- ------- -----------Phone ............... <br /> ......................... <br /> Address ---//-_1y�?-------/y,----- .7----------------- <br /> oln;4_,10---------- ---------------------- City 4/ <br /> Contractor's Name -------- --------:��------------------License # ---- Phone _5W--------K--------- <br /> Installation will serve: Residence F-I Apartment Housef] Commercial IKTrailer Court [I <br /> Motel F1 Other -------------------------------------------- <br /> ; Q <br /> Number of living units:------------ Number of bedrooms ------------Garbage Grinder ------------ Lot Size *__�-------------------...................... <br /> Water Supply: Public System and name ----------------------------------------------------------------------------------------------I-----------------Private <br /> Character of soil to a depth of 3 feet: Sand'El Silt.F] Clay [I -'Peat El Sandy Loam El Clay Loam F-1 <br /> Hardpan F� Adobe,,115;f Fill Material _A140i- 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 feetJ <br /> PACKAGE TREATMENT SEPTIC TANK Size_��_,�_�?------ ------------ Liquid Depth -------------- <br /> Capacity/,� pep e 4t No. Compartments ....... ..... <br /> t!:�_-O)�Materia I AflO--------- <br /> Oa-------- Ty f p. Line N <br /> Distance to nearest: Well ----------------------Foundation ----------- Pro <br /> ""'IS I - 4KS I h ---- ------------- <br /> LEACHING LINE �K No. of Lines -----;�7--------------- Length of each line---------------------------- Total Lengt <br /> 'D' Box -----/--- Type Filter Material 4A-w---Depth Filter Material ------/9------------­-----I....... <br /> 1 5 1 )V/,Ov - <br /> Distance to nearest: Well -------- Foundation _36---------- --- Property Line - ------------------ <br /> SEEPAGE PIT 45�_1 ----- Diameter 3-6-'*' ------ YesX No 0 <br /> IV Depth ---- ------- Number ------------- Rock Filled <br /> Water Table Depth ---------9 -1------------------------_----Rock Size --------------- <br /> /1?4L 1 -5 <br /> ine ........�#A----- <br /> Distance to nearest: Well -----------------------Foundation -—---------------- Prop. L <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------- <br /> Septic Tank (Specify Requirements) -------------------------------- ----------------------------- ---------- -------- ---------------------------- <br /> Disposal Field (Specify Requirements) --------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------- ------------------------------------------- ----------------------- <br /> ---------- ---------------------I----------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work wi.11-pe done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquinlocal 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 orkman's Compensation laws of California." <br /> Signed _Gtit 1 1 .7------2 e F , C__ __ Owner <br /> -------- - - ------- ------------- <br /> By ----- ------------------------------- - --- ------- -- --- -- ----------- ------------- -Title ----- ------------------------------------------------------------------ <br /> (If other thaiowner) <br /> FOR DEPARTMENT USE ONLY <br /> AV <br /> APPLICATION ACCEPTED BY ----------------------------------------------------------- DATE­#!k-____--4�_- <br /> BUILDINGPERMIT ISSUED ----------------------------- --------------------------------------_---------------------------------------DATE ------ <br /> ADDITIONALCOMMENTS -------------------------------------------------- ------------------------ ------------------------------------------------ ------------ <br /> ---------- ------------------------------------------------------------------------------------------------------------ --------------------------- ------------------- ---------------------- <br /> -------------------------------- --------------------------------------- ------------------------------------------------------------------------------------------ <br /> ------------- ------------/I-- ----------------------------------------------------------------------- -------------/ -------------------- <br /> ---- ---------------------------------------------- ------- -- --- --- ----------------- ----------- <br /> Final Inspection by: --------------- -----------------------------------------------------------Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />