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f <br /> FOR OFFICE USE: e <br /> APPLICATION FOR SANITATION PERMIT <br /> ........�1 <br /> ..... ........ ............ Permit No. <br /> plete in Triplicate! .. ... ..'. .. <br /> {Com ,` 7 <br />.......................... .. ......................... This Permit Expires 1 Year From Date Issued <br /> 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 .. _. 3 g.3..._ ..........:........CENSUS TRACT .:.......:•-- •--:.:_• <br /> Owner's Name ._. .,e. -------------•--- ---•--..._.......__.............Phone ........................... <br /> Address --'..::._.-. ....... city'.. . ..... ... .. / .:_......... ..................... <br /> Contractors Name _..License # �--:.. Phone <br /> ... <br /> Installation will serve: Reiidence Apartment House0 Commercial oTrailor Court 0 <br /> Motel ❑Other ----------........:......................... I <br /> Number of living units .... Number of bedrooms ___.....Garbage Grinder ------------ Lot Size .__ -��- .._........: <br /> Water Supply: Public System and name ...................................._...........................................................................Private <br /> Character of soil to a depth of 3 feet: = Sand 0 Silt O-+ -Clay...0__P1 eat,© ,.5andy.,Loam fl Clay Loam 0 <br /> Hardpan Adobe 0 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.} i <br /> NEW INSTALLATION: (No septic tank or see ge pit permitted if ublic sewer is available within 200 feet,) . <br /> PACKAGE TREATMENT SEPTIC Sizell, <br /> •.I .? � ......... Liquid Depth .-.�.�............•....... <br /> .� <br /> Capacity Type .. Materiai.._.. . No. Compartments <br /> ...... <br /> W <br /> Distance to nearest: Well ...........; Pk.__....-_•_--__•• Foundation ....�P__---------- Prop. Line �...�.__.._..__W <br /> LEACHING LINE [!� No. of Lines ._ Length of each line......./_�.0_ ......... Total Length ..�....................... <br /> 'D' Box .:.- Type Filter Material - ._. Depth Filter Material ....if_~_... ­.­­ <br /> Distance <br /> Z i <br /> .................••••••- <br /> Distance to nearest: Well ____....5 o..._._..... Foundation ...... ................ Property -Line ...1................... <br /> SEEPAGE PIT [0� Depth ..._c.1.5......... Diameter -._. ��. '.. Number ---------- _"_____________- Rock Filled Yes No <br /> Water Table Depth _-----:-_F0 •........................Rock Size __LIQ•.... ....... <br /> Distance to nearest: Well ..................Foundation Prop. Line <br /> ................ <br /> REPAIR/ADDITION(Prev. Sanitation Permit;# ...............................:............ Date ................................... <br /> j <br /> SepticTank (Specify Requirements) .....--•---•-••---- ..............................................................................................--••----- -•-------•--....------•--.__-----•--•----••................................................._------__...-._... <br /> Disposal -Field (Specify Requirements) ........................ ................ .............................................. <br /> _.._..-•---------------------------------•----•----------•------.._._...•--..._..._...._..._.. .......................................-_---------.................................................. <br /> (Prow existing and required addition on reverse side) y <br /> I hereby certify that I have prepared this application and that the woik will be done in accord ance:,wi th Son Joaquin i <br /> County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen. i <br /> sed agents signature certifies the following:. <br /> "I certify thdt in the performance of the work for which this permit is issued, I shall not employ any person in such manner k <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed .......................... ---•. ....... ----- Owner <br /> - <br /> 8Y ...._.. .! .... Title . ''���'-Au _ <br /> ------------------------- <br /> (If other than owner} <br /> FOR DEPARTMENT USE ONLY <br /> 5" �—o� <br /> APPLICATION ACCEPTED 8Y- - ---•--- - ._ ..-••....... •-•:..........-------------------------------------------•----.. DATE-..............---------- -��-....... <br /> BUILDINGPERMIT ISSUED .................................... ...................: ....:.....---...---....--•••-•--••-:. --•-•-•DATE __.----------•--••----•••••--•-_--•--_..... <br /> ADDITIONAL COMMENTS <br /> ................................. -......... ........ .- .............................. .............. <br /> Final Inspection by: t.- - -Dote _�- ............................... <br /> SAN JOAQUIN LOCAL' HEALTH DISTRICT ;/ <br /> �— F- I-I- 13 24 1.-AR o.. FAA 7/72 3-N <br />