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FOR OFFICE USE: � � APPLICATION FOR SANITATION PERMIT �_ 5�� <br /> . <br /> ...................................................... 7Perm <br /> (Complete In Triplicate)- <br /> ..;.......:.... :V ... ..... .. ..... aro las <br /> This Permit Expires 1 Year Front Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constrict and install the: wor.,- <br /> described. This application Is made In compliance with County Ordinance No. 544 and existing Rules and RegulatlonV <br /> �J <br /> JOB ADDRESS/L TION -`F � ��� ....CENSUS TRACT <br /> Owner's Name �. . ............ `............................................... -'...............Phone ----•-... ......................... <br /> Address .....7) 'f.. ... ,.__ :....... ............Clty .......... ........................................... <br /> . <br /> Contractor's Name .............................................License # .1 49 �2•Phone ..rd�.r'� -••- -- �.:� <br /> Installation will serves Residence PApartment House Commercial oTrailer Court ❑ <br /> Motel 0 Other....... .................................... <br /> Number of 1iving units:.-- Number of bedrooms -.6......Garbage Grinder ............ Lot Size ............................................ <br /> Water Supply= Public System and name ..................................._------------........_...................................................private a <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat o Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan® Adobe 0 Fill Mcterial ............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: (Na septic tank or seepage pit permitted If public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT .O SEPTIC TANK I j Size..�............................................ Liquid Depth ...-----.................. <br /> Capacity /Z<?...... Type ..6f0t e` Material.. ... No. Compartments ............ <br /> ....... <br /> ..""Distance to nearest: Well ...................Foundation .... a............ Prop. Line ...................... <br /> LEACHING LINE . [ ) No. of Lines _3............... Length of each line... V....-............ Total Length .: 1................... <br /> 'D' box ..tl----_--- Type Filter. Material ...�dt:E0..�...Depth Filter Material ....��`�............................... <br /> r • , Distance to nearest: Well ......................... Foundation ........................ Property Line ........................ <br /> EEPS AGE PIT E B Depth j- <br />�. --------•--._..__... Diameter ................ Number .---.....--•--•------....:.. Rock Filled Yes ❑� Na ❑ <br /> 6 ` <br /> Water Table Depth ................................................Rock Size .............................. <br /> Distance to nearest: Well Foundation <br /> REPAIR/ADDITION{Prey. Sanitation Permit# ----------------------- .................... Date .................................4. <br /> SepticTank JSpeclfy Requirements) -----•............................................................ ........... .................................... ........... <br /> DisposalFiela (Specify Requirements) ---------------------- -------------------------------•--•......----........................._....-- ............................... <br /> • <br /> ..................................................... .._.,._......................................._................................... ---.............----••-•---... ............. <br /> • (Draw existing and required addition on reverse side) <br /> ' .1 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 !Regal h'e aquin Local Health District. Home owner or licen- <br /> i: sed agents signature certifies the following: <br /> "I certify that in the performance of the work for whlc `r ermi# *sued, 1 shall not employ any person in such manner <br /> as to become subject toWorkman's ampensatien laws of California." <br /> Signed ---.-.� .......... . ........ <br /> ........................................................ Owner e - <br /> Sy .................................'.....................................- ..........--------- ----.. Title ...................--................:............:......:._... ......._ <br /> jif other than owner) ° <br /> FAR <br /> DEPART 'T V ONLY . <br /> APPLICATION ACCEPTED BY.- - ...............: DATE .........,.. .. <br /> BUILDING PERMIT ISSUED DATE ...:- <br /> ................ .................-• ... .......-•--.. .......... <br /> A€�DITIONAL COMMENTS '-"� <br /> -- -. ........................................ ................... <br /> . ...........•--••..........:......................................................... ............... = ............----..............-:................................. <br /> .......................•-----•-.-•-.-- ..-...... ............ .............................:......... ...................--........ <br /> ...................... :.-... .-•--- ....................---.... .... .......... <br /> y!+ <br /> Final Inspection by -' ..... ................................Date ........... <br /> Edi 13 24 1•-68 Rcsv SAN lOAQUIN I-QCAL�yyHEALT DISTRICT 8/7h 3M <br />