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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ------------- K----------.------------ <br /> (Complete in Triplicate) Permit No. <br /> ___ ___________________ This Permit Expires 1 Year From Date Issued Date Issued <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 _________CENSUS TRACT _______________ __________ <br /> Owner's Name ------- y Lc1-------,1300x!,-�------------------------------------------------------ --------------------Phone ------------ <br /> Address ----------------------C/y�41----- --------------------------------- --- City ----5,Amt_41-- -------------------- -----_-------------------- <br /> Contractor's Name ____ e__t�Ar-AFS___-_-_-c____��_r�_n t- � -------License # --_,�-�1g�7� Phone �'�`���-------- <br /> Installation will serve: 19`{s-, eR side <br /> 4 nce j�'Apartment House❑ Commercial❑Trailer Court ❑ <br /> Motel ❑Other -------------------------------------------- <br /> Number of living units:-----/----- Number of bedrooms :__o?,�..Garbage Grinder _________ Lot Size -,-el---------�----------v---------------- <br /> Water Supply: Public System and name ---------------------------------•---------------------------------------------------------- -----------------Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ AdobeX 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: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK Size----------------_------------------.------------ Liquid Depth __________-____-_____---- <br /> Capacity __/_HCl?__,__ Type Material____�'� Gi�c Plo. Compartments _-�2................ <br /> Distance to nearest: Well ------&FV-------Foundation ____ _____________ Prop. Line _1_4)............ <br /> LEACHING LINE [ ] No. of Lines ________________________ Length of each line---------------------------- Total Length ----------- ................ <br /> 'D' Box ____________ Type Filter Material ____________________Depth Filter Material _____________.-_____.______----.-.._..----.- <br /> Distance to nearest: Well _______________________ Foundation ------------------------ Property Line _.__________-____---.-._ <br /> SEEPAGE PIT [ j Depth _______. ---------- Diameter ________________ Number ______ -------------------- Rock Filled Yes '❑ No i❑ <br /> WaterTable Depth ------------------------------------------------Rock Size -----------•--------•----------- <br /> Distance to neargst: Well -------------------------------------=--Foundation -------------------- Prop. Line -_.------------------ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ________________________ ------------------ Date -------------------------- ------- <br /> SepticTank (Specify Requirements) ------------------- --------------------------------------------------------------------------------- --------«------------------•----- <br /> Disposal Field (Specify Requirements) -----------------------------=----------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------ ------------ -------------------------------------------------------------------I--------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------- ------ --------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certify that 1 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 sub'ect to Workm 's Compensation laws of California." <br /> Signed -- - --- --------------------------------------- Owner <br /> BY --------------------- -- - - -- _ _ t---- - --- ----------- - ----------------------- Title ----- ---------- -------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- DATE ------'/�Tz <br /> BUILDING PERMIT ISSUED ---------- - ----- ----- ---------------------------------------DATE - ----- --- ----- <br /> ADDITIONALCOMMENTS --------------------------------------------------------------'---------------------- ------------------------ ------------------ =------------------ -------- <br /> - tl __ *_ -- ---------- <br /> - <br /> - --- _ __ _ _ <br /> Final Inspection by L. -". - Date <br /> ----------------------- ---------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />