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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT hh \ <br /> ................................. Permit No. <br /> (Complete in Triplicate) �-�- <br />.................... -- <br /> V..V............._....... 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 /> + J <br /> JOB ADDRESS/LOCATION :..........................CENSUS TRACT S.` 7-................ <br /> Owner's Name .. _..... .Xrs;l..................................................... ............. . ...............Phone .................................... <br /> Address .......�✓ , ! ®!�*---•-•• ....I.. .......................................... City .40.4// ............................................................. <br /> Contractor's Name ....I—efre.-.7r.ee_ev -�-----------------------------------------License # Phone .���... <br /> Installation will serve: Residence $Apartment House❑ Commercial ❑Trailer Court C3 <br /> Motel ❑Other ............................................ <br /> Number of living units:..,, ..... Number of bedrooms .....Garbage Grinder IVP... Lot Size I.A6JK ...................... <br /> Water Supply: Public System and name ...-----•-•-•.....-••----•----....--•••••-----•-......----•-........•--..........•--••........................Private f� <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam D <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 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK ja�/m,4Size................................................ 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 ............................d <br /> 'D' Box ............ Type Filter Material ....................Depth Filter Material ........................................... <br /> Distance to nearest: Well ........................ Foundation ........................ Property Line ....................... <br /> SEEPAGE PIT [ ( Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No ❑f <br /> WaterTable Depth --•-•...........................................Rock Size ...__..............••-•... ..... <br /> .........................Foundation Pro Line <br /> Distance to nearest: Well ............... ..._................ p. ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit ........................................... Date .................................. <br /> Septic Tank (Specify Requirements) ...................... --. ._.._........-........ ........ ............................................... <br /> Disposal Field (Specify Rpquuiirements) ....496— i- .•-• fes Vii?- •-• _•�-•- ` � . <br /> -----------.•-------------- --------------------------------------------•---••--------••-----•-----•----•-•--•--- •---•-------.--.--••.---•--..._ . <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 subject to Workman's Compensation laws of California." <br /> Signed ................ •-• -••-••--...... ........... ................................ Owner <br /> By ....................... .. ..... ................................................ Title . jo -................---.......---...........: <br /> (I ther than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ..._4 ..................... ................................ DATE ............ <br /> BUILDINGPERMIT ISSUED ...•--•..............••...................................................................................DATE ........................................... <br /> ADDITIONALCOMMENTS ...........................................................................•-----....-•--•-.... .............................................................. <br /> .................•---•------•••---...............................................••----.........................••••-•---......................................................•-•..................•-•- <br /> . ............. ........... <br /> ...............•••-••••..............•--.. ......... <br /> ..es <br /> ...... •--•-•-- .....--•-•---....------..........-•-•----•--......................--•...._.......... .---••....................•••-•-•-•............. .....---....................---......•••.................... ...Final Inspection by: t' .. .. ................................................Date 6•-.. ............... <br /> a SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H.13 241.'68 Rev. 5M 7/72 3 M <br />