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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ---- ------- - ----- --------•- Permit No. ..,7`±l-_i-y�l <br /> / (Complete in Triplicate) <br /> __.____ . <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 <br /> ----- ------------------------------------------------- --------------------- -CENSUS TRACT ---------^- ------ <br /> --- ��� �'= l- l_-� _f l' -----------------------------.---------------- -------Phone <br /> Owner's Name .. --��'---'�--'-- <br /> Address ----- = I 5'/--------r . -.....I ----------- - --. City _�' -arv-------C/ -------- ------- -----------------•--- <br /> z c S <br /> Contractor's Name ; . - f _ / - ---------------- License .��.l� Phone -` <br /> Installation will serve: Residence [$'Apartment House❑ Commercial ❑Trailer Court ❑ <br /> Motel ❑Other -------------------------------------------- <br /> Number of living units:-----f------ Number of bedrooms .A......Garbage Grinder ------------ Lot Size -------------------------- ----------------- <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 :❑ �Q <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type __-________________________ i <br /> (Piot 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/Ite <br /> Size______ _____________________-.-.- -- Liquid Depth -_--_-_________._._-_.-.- <br /> Capacity -------------------- pe ------------------- aterial------------- No. Compartments .. <br /> Distance to nearell ________________ ______-_______._•_Foun tion _-______-.__.________ Prop. Line ...................... <br /> LEACHING LINE [ ] No. of Lines -_--_- ___-_- Lengt of each line----_ _____--._-__--___- Total Length --------._----------------- <br /> 'D' Box ------------ Tter Mat ial ____________________ pth Filter Material _--_--_-____________-___-...___--.----_.-_-_ <br /> Distance to nearesl ---- --------------_-_ Found ion --------------- -------- Property Line __.____..........._.._. 1 <br /> SEEPAGE PIT [ ] Depth ___----_._-._-__- ter ________________ Nu ber ---_-.-_-___---_-____-__-_-_ Rock Filled Yes '❑ No i❑Water Table Dept ------------------------------- --------Rock Size ---------------------•---------- <br /> Distance to nearest --------------------------- - ---------Foundation -------------------- Prop. Line ..___...._.._...•••.-- <br /> REPAIR/ADDITION(Prev. Sanitation Permit _______________________ _____________ Date ____________________--__------___-) <br /> Septic Tank (Specify Requirements) --------------------------------------------------------------------- --------------------------------------------•------------ <br /> Disposal Field (Specify Requirements) .----------------------------------------------- --------------------- ------- ---- <br /> ------------ ----- _ --------- �`�=5 ,��� ' --`--------""'-------- <br /> ------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> I 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 Workmo <br /> r's Compensation laws of California." <br /> 71 <br /> Signed . - ----------------------------- ------------ - -------- Owner <br /> ll/ <br /> P------ <br /> � ��-� ------------------ Title ------ ----------- <br /> By (If other than owner) <br /> �T- FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----...[..R._0----------------- ---------------------------------------------------- DATE ------ ._----- 7 <br /> BUILDINGPERMIT ISSUED --------------------------------------------------------------------------------------------------------DATE -------------------------- ---------------.. <br /> ADDITIONALCOMMENTS ------------------ ----------------- ------ ---- ----------------------------------------------------------------------------- <br /> ------------------------- ------------- ----- --- ------- - --------------------------- - ----- -- - -------------------•------------------------------------------------------------------------- <br /> ------------------------------------------ -------- ----------------------------- - ----- --- - ----------- <br /> ---------------------- ------------------ ------ ----- - -- -------------------------- <br /> Final Inspection6 : - ------------------------------Date - .--.�2— <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />