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FORQFFICE 115E: APPLICATION FOR SANITATION PERMIT <br /> ...... <br /> Permit No. <br /> ... ........ ............ ..7 -. `! <br /> CU <br /> (Complete in Triplicate) � • <br /> This Permit Expires 1 Year From Date Issued Date Issued .,� .�:.7,v <br />......................................................... <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 /> JOB ADDRESS/LOCATION ..>.96---04- ..1 '................ ..................CENSUS TRACT .......................... <br /> Owner's Name .. .:.... .................................................... <br /> .........................I............Phone .................................... <br /> Address ............. /,?1�. ..... .......... ....................................... City .+e � ............................................... . <br /> Contractor's Name ..... et®1� - �� ......................................License # •.. Phone� .........:.... <br /> Installation will serve- Residence 0 Apartment House❑ Commercial ❑Trailer Court <br /> Motel ❑Other ............................................ <br /> Number of living units:..../..... Number of bedrooms .......Garbage Grinder Zk ... Lot Size ................. <br /> Water Supply: Public System and name ....... dolil-.... '<G'r...r lit /.f !! !...................................Private ❑ <br /> Character of soil to a depth of 3 feet: Sand n Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe 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 208 feet,) <br /> PACKAGE TREATMENT [ I SEPTIC TANK t ] . Size................................................ Liquid Depth .......................... <br /> Capacity Type Material No. Compartments .. . <br /> Distance to nearest- Well ....................................Foundation ...................... Prop. Line ...................... <br /> LEACHING LINE [ J No. of Lines ........................ Length of each line............................. Total Length ............................ <br /> 'D' Box ....--...... Type Filter Material ....................Depth Filter Material. ............................................ <br /> .... Pro Line <br /> Property Distance to nearest. Well ........................ Foundation <br /> SEEPAGE PIT [ ) Depth .................... Diameter .:.............. Number ....._... .................. Rock Filled Yes ❑ No ❑ <br /> Water Table Depth ............... ..............Rock Size 17 <br /> Distance to nearest: Well...........::.:.........................Foundation .................... Prop. Line ......................, <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _........................................... Date ........................_ ........ <br /> Septic Tank (Specify Requirements) ...................... `............ ..... ............. ................_ • ................_..........._..... <br /> Disposal Field (Specify Requirements) ...... " .... -.-•-1--•..•-, .X �'•-•---••-•--h <br /> ------------------- ..................................... ••••-•-----••--------••---•••-•••--•----------•...•--•---••-•-.....--..................... <br /> ......-- --•---....----•-----•••-------•-------------•---•••......................•---............--•-._...-----•---••----•-...............------ <br /> (Draw existing and required addition on reverse side) <br /> 1 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, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ..........................• -------- Owner <br /> By ..... .. ..............•....._. ....... ......................................... <br /> Title l .................................... <br /> (if oth an owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION -ACCEPTED BY ............ DATE 7�D�1.74—:•-.---•- <br /> BUILDINGPERMIT ISSUED ...................-•...................:....•--••-•---•-•................................................DATE ........................................... <br /> ADDITIONALCOMMENTS ...........•......................................................_...........---.........................--•••-..................:........................... <br /> ...........................-------................................._.........-----....................................................................................... <br /> . <br /> ........................................ <br /> . .. ...:.. ......... .:....--•.....-..----......................------........ <br /> ZZl <br /> ---•••-•--•-... .............�/ .. . . ..........-•...................................................................... --.......... <br /> �... _... .. .-. <br /> Final Inspection by: ............... . . . .........................•--...............................................................Date ........ <br /> SAL H .. ... .11.. <br /> N JOAQUIN LOCAL DISTRICT <br /> E. H.13 241.'68 Rev. 5M �K 7/72 3 M <br />