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w. FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT <br /> , 'f <br /> ------- ----) ------------------------------- Permti'r4o U <br /> (CoZsipl4te.!Ah Triplicate) <br /> ------------ ,P <br /> ----------- ---- Date Issued --------I----------- <br /> I This Permit Expires 1 Year From Date Issued <br /> ----------------------------4-�- -- ---- ------- <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/LOCATIONX-47- ------ ---- ---CENSUS TRACT. <br /> ----- --------­---------- <br /> I I i . <br /> -----------------------------------Phone ------------------------------------ <br /> Owner's Name!-- <br /> ---------------------------------------------- <br /> Address ----- - -- - ---------- ------------- 7 City q-. rAllwe <br /> ---:W/7 <br /> 7 *7/ <br /> #a;2 <br /> '00or - - -- - ----------------------------- <br /> - Phone�W,17249M:?­ <br /> Contractor's Name 'a------- <br /> Installation will serve. Residenc-VApartment House,[:] Commercial [-]Trailer Court E] <br /> /EM6 <br /> Motel ❑M Other ----------- ---- ------ - ---i f <br /> 101' <br /> Number of living units-------------i'Number of bedrooms -J- -------Garba-ge Grinder -1Ve- Lot Size ............... <br /> i El <br /> Water Supply: Public System and name ------------------------ -----------------------------Private <br /> I <br /> Character of soil to a depth of 3,,feet.. Sand'o Silt E] Clay 0 Peat F] Sandy L6arn E] Clay Loom E] <br /> Hardpan E] Adobe SK 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 seep6ge pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT 1 ] SEPTIC TANK Size__X -Ae_447 -------------- Liquid Depth --------_-_-,.-1-_- <br /> Capacity <br /> Ty' pe/09ir-A-4!---- Material �4"----- No. Compartments I------------------- <br /> I - 011 <br /> Distance to nearest: Well ------------------------------------Foundation .,,.0V------------ Prop, Line <br /> LEACHING;LINE nes ---.2---------------- Length of each line--o-V-7-#4 <br /> No. of Li ........ --- Total Length 402e---------------­ <br /> I 00,0W <br /> D' Bo Type Filter Material/exlel)epth Filter Material , 47-------------- ------------------ <br /> -n -a -_-----_--- — --------------- <br /> Distan�vt �rest: Well -- ---------- Foundation -X.0---------------- Property Line <br /> --- 4r <br /> SEEPAGE PIT Depth - - ----- -- DiameterA4?--��)V(? Number A—--------------------- Rock Filled Yes No C, <br /> Water Table Depth ---40-1 —------------------------------Rock Size A ---------------- <br /> Distance to nearest: Well ------,..-------------------------------Foundation -/p-.._-_--- Prop. Line ----ItA.,------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit=# -------------------------------------------- Date ---------------------------------- <br /> SepticTank (Specify Requirements) -------- ---------------------------------------------------------------------------------------------------­­11--------------------------- <br /> Disposal Field (Specify Requirements) --------------------------------------------------------- -----------------------------------------•----- ----------- --------------- <br /> --------------------------------------------------------------------- <br /> -------------- <br /> --------------------- ------------------------------------------------ <br /> --------------------------------------------------------------------------------------------------------------­­----------------- <br /> ----------------------- ----------------------- A-------------------------------------- ------------------i-----------------I------------------------------------------------------------ <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 Ordinlances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner ar licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to becomWsubject to Workman's Compensati;n laws of California." <br /> Signed -------i-------= <br /> Owner <br /> - <br /> By ------ - - ---- ------------------------------ Title <br /> - --- <br /> er than owner) <br /> PARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------ - --- ----- ----------------------- --------------------------------- DATE1------- ------------------- <br /> BUILDINGPERMIT ISSUED ----------- ------ --- -------------------------------------------------------------DATE .------------------------------------------ <br /> ADDITIONAL CO tA NTS ------- ----- ------ --- -- - ------------------------------------------------------------------J:------------------ -----------------:----- <br /> V I"Z� - - , ------ -------------------- <br /> ----------------------- ---- - --------- -- -- --- - - --- - ------------------------------------------ ------------ ------------------------------------------------- <br /> ------------------------ ---- - -- - ------------------------------------------------------------------------------------ --------------------------------------------- <br /> --------I----------- ------------------- - --- -- - ------ -- ------------------------------------------------------------- ------------------------------------------- -------------------------- <br /> Final Inspection by.. ------I------------------------- -------------Date ------- - ------ <br /> --------------------------- V <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> E. <br /> H. 9 1 '68 ev. 5M A <br />