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} <br /> FOR OFFICE-USE: APPLICATION FOR SANITATION PERMIT // <br /> --------------- - --------------------------------------- <br /> (Complete in Triplicate) Permit No. -7---------------- <br /> 1-�0.3 <br /> � <br /> --------- ------------ -- <br /> Date Issued <br /> --- - <br /> This Permit Expires 1 Year From Date Issued <br /> ------ <br /> ------------- <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 /> n <br /> JOB ADDRESS/LOCATION .---9-7--� ___ ----- d_L.�L.J/YLI ---1-G -------•--------------CENSUS TRACT -------------- ------ <br /> l7 __ �•+. ..---- egp-----�%� ✓c�---------------------------- -------------Phone,e,- �� �----- <br /> Owner's Name .- -' <br /> ---------------------------------------------------- <br /> Acidress _-/_. v1-----.--------- City .� �/a <br /> ,�!} _ <br /> Contractor'.s Name -------�=Y ' -.. -I��i�� License # -y[ jl-------- Phone � _ .4--- ---_ <br /> Ic------------------ <br /> Installation will serve: Residence ❑ Apartment House❑ Comm tial ❑Trailer Court !❑ <br /> V <br /> Motel [7] � <br /> Other ..- ?- - <br /> Number of living units------------- Number of bedrooms ---t�-----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 ;[] <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ---------------------------- <br />` (Pl'ot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) `n <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT f ] SEPTIC TANK:[ ] Size___ ----U:- __ Liquid Depth _�� <br /> Capacity --- -- Type _Pula" erial__�.0_t-�'- o. Compartments _ --------_....... <br /> '� <br /> Distance to nearest: Well ----'�-�----------------------Foundation --/0------------ Prop. Line --------------•------- <br /> LEACHING LINE [ ] No. of Lines ------3------------- Length of each line.--, _ -------------- Total Length a2O__.--------_-- <br /> 'D' Box ------------ Type Filter Material _ _---Depth Filter Material - --------- ------------------------ <br /> I Distance to nearest: Well -----C�Tr4----------- Foundation -I_________-- Property Line -- --------------- <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes 'f] No i❑ <br /> WaterTable Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------- <br /> ---------------- Date ---------------------------------- <br />' Septic Tank (Specify Requirements) -------------------------------------------------------------------------------------------------------------------------------------------- <br /> i <br /> DisposalField (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- <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 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 Workm n's Compensation laws of California." <br /> Signed = ------- ------------------------�'- - ------------------------------ Owner <br /> BY -- ----- ---------------------------- Title ----- ---- ----------------------- -- - ------------------------------- <br /> (If other than owner) <br /> i <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- -- --- -------------------- -------------------------------------------------- DATE -_ -- --`� <br /> BUILDINGPERMIT ISSUED --------------------------------------------------------------------------------------- -------------- ---DATE -------------------------------- ---------- <br /> ADDITIONAL COMMENTS ------------------------ --- - ------------------------------ ------------------------------------------------------ ------------------------•---------------- <br /> - <br /> ' ----------------------------------------------------------------------- <br /> ----------------------------- ---------------- - - -- ----- - ----------------------- ---------------- <br /> . � <br /> ------------------------------Date ---�- ------ -------------- <br /> ----------- <br /> - ---Final Inspection by.. -------- ------------- - <br /> o SAN QUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />