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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. ��--"---- ------ <br />-------------------------------------------------------- (Complete in Triplicate) L <br /> I <br /> --- --------- p Date Issued --- <br />---------------- <br /> This Permit Expires 1 Year From Date Issued <br />-------------------41, --1- ---------------- <br /> o construct and <br /> Application is hereby made to the San Joaquin Local <br /> Health <br /> Disttfor <br /> Ordinance permit <br /> t and existing Rulesinstall <br /> andRegulations:work <br /> heein <br /> described. This application is made in compliance Y <br /> �!s <br /> .F CENSUS TRACT <br /> JOB ADDRESS/LOCATION - - <br /> ��1� Phone <br /> Owner s Name -__ .�,--- - l------- <br /> -, 4�z -_• �. ---- Cit ------------!vl / Jv� f <br /> Address �3�E . �� _> _,l�� I_=�' s, - ---- ---- --- , �. � -------- -��� <br /> - y � <br /> ,,��•�� 1 - License # � �/� Phone �e - -- - <br /> Contractor's Name _- 'C4,/ —- -�-�" �/� <br /> Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court ;❑ <br /> Motel ❑Other ------------------------------------------ <br /> Number of living units: ---- Number of bedrooms _____Garbage Grinder Lot Size -- <br /> ------ <br /> Private [� <br /> Water Supply: Public System and name ____________________ _ <br /> - - - ------------------------- <br /> ------------------- <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay 4 Peat Sandy Loam El Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material -Wo____ If yes, type ---------------------------- <br /> (Plot <br /> ______.__------__(Plot plan, showing size of lot, location of system in ation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepa pit permitted if public sewer is available within 200 feet,) <br /> !� �` Li uid De th -----&----------------- <br /> PACKAGE TREATMENT [ I SEPTIC TANK'[ Size,_ - -- ------ -- q p Lv <br /> j,AjC', T e' - �' `_ Matenal� '��"'�X� C No. Compartments --�= - <br /> =' NS. <br /> Capacity `"-- ---- YP • s-=� <br /> istance to nearest: Well ___1"541-------------------- --Foundation ___ -l�_'----- -_-- Prop. Line ._ .�_.------------- <br /> �i r� <br /> �`3--------------- <br /> each line_ _ __._ Total Length -�-7--�-�-------------- <br /> LEACHING LINE No. of Lines ____,_ Length of - - ,( '0f <br /> 'D' Box _________ Type Filter Material .t <br /> -2e_ .....--__Depth Filter Material _ -1 ---------- <br /> ----------- <br /> ---r-�/---- Property Line ------ <br /> Distance to nearest: Well .__�`��}-<--;----f Foundation - - - - p Y <br /> < r' Rock Filled Y 1-5 <br /> es No i❑ <br /> SEEPAGE PIT [ Depth Diameter ��3---- Number -_��-"�` <br /> Water Table Depth -----/ ---- ----------------------- Rock Size _xR <br /> Distance to nearest: Well ____lC ' -_C--------------------Foundat' n ____� �__-__..__ Prop. Line _.__ --•-•-- <br /> Date ------------------ <br /> ----------------) <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _------ ---------------------------------- <br /> Septic Tank (Specify Requirements) ------------------ ------------------------------------------- ----------------------------------------- <br /> -------------------------------- <br /> • <br /> Disposal Field (Specify Requirements) -----------------------------•------------------------------------------ <br /> ------------------------------------------- <br /> --------------- <br /> ------------------------------------------------------ ---------------------------- <br /> ------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> I 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 #f the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: erson in such manner <br /> "I certify that in the performance of the work for which this'permit is issued, I shall not employ any p <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ------ -------------- <br /> , <br /> r- -� ----Vi---c-'-/-------_-_ <br /> ----- <br /> ---L------------- �------------------------- <br /> Owner <br /> Title --- - <br /> ( f a- --- ----By ---- --- other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ____---F -43-7, ___. DATE _.._�--'-��---�-�-�--"- <br /> BUILDINGPERMIT ISSUED ---------- --w------------------------------------------------------------------------------------- DATE - <br /> ADDITIONAL COMMENTS --------- --- ---------------------- - ------------------- - - A- --- <br /> I <br /> _ _.f_____________________________________ <br /> __r+_____________________ ____ __ <br /> -- ----------------- <br /> -- <br /> ----------------------------- -- ------------------ ---- <br /> r -- --------------------------------------- <br /> -D( <br /> --- -- --- - <br /> -- -- Date Y---- <br /> - <br /> Final Insp <br /> l ------------------------------ <br /> SAN <br /> = ---- ---- ' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E H. 9 1-'68 Rev. 5M <br />