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t' <br /> COR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 <br /> .... . Permit-No. ---.-........a-....5 <br /> (Complete in Triplicate) <br /> -- -----------=--- This PerntitEx )res 1 Yearfrons..e—�__ ..,_.._...- .,..�.:D �___......_ <br /> _. _. ._ <br /> .................... This P Date Issued <br /> Date Issued .3.-.L.�:7.7 <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 mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCA ON .. -��- J .-_. _...�. . �ID��.....,.._.. ......................CENSUS TRACT .......................... I <br /> Owner's Name !;� •--.......................,.................. .... Phone ......... ......................". <br /> -""- ...-- ".-"-" <br /> Address .._ .. City -rn�z <br /> ....... ...................... <br /> Contractor's Name --- .. ....... ........n_... .. .. .. .__. ......License► Ila ..1 + r Z Phone ......:...............•....... <br /> M <br /> Installation will serve: Residence 0AApartment House fl Commercial QTraller Court C] <br /> g <br /> Number of living units:......____ Number of bedrooms Garbc <br /> f <br /> Motel E]Other................:....... ... <br /> . 4.4....Garbage Grinder Lot Size ... ........... <br /> Water Supply: Public System and name .........:..............: ❑/ <br /> ................•---....-•---••------- ---•............................................Private <br /> Character of soil to a depth of 3 feet: Sand Q Silt❑ Clay ❑ Peat Q' Sandy Loom ❑ - Clay Loom ❑ O <br /> Hardpan Adobe 0 Fill Material ............ if yes,type ...........I... ............ O <br /> 6 (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 seepage pit permitted If public sewer is available within 200 feet,) j. <br /> y' PACKAGE TREATMENT [ ] SEPTIC TANK S€xe.......................... <br /> --�`x « ' �' �.................. Liquid. Depth ....`/... ........... . <br /> Material-._..._...__._... — No. Compartments .r"Z-------.. � <br /> Capacity YP ..-• ----- ......._ <br /> Distance.to nearest: Well ----••---- �--- .. -...........Foundation ......1.Q_.......... Prop. Line .....Jr............ <br /> -` <br /> LEACHING LINE [+� No. of Lines .............. length of each` line--------4.°...". ........ Total Length ...i.�-: /.--... .... <br /> D'_Box ............. Type f=ilter Material ..... Depth .Filter Material ......_t`t=................................ <br /> Distance to nearest: Well -------5' -- FouMation -..Jp .... Property line E r <br /> SEEPAGE PIT `� <br /> [� Depth ----cr`�.S;..__--- Diameter _.._--_r ____-- Number :.-•----- .:�;......i......�Rock Filled Yea � No 0Water Table Depth ---------------L o°.........................Rock Size ._:._l:_.l._.? .3_.__.----- <br /> Distance to nearest: Well ..........t-1Q.P.............-::____Foundation ----J.-V.......... Prop. Line ...................... <br /> itEPAIR/ADDITION lPrev. Sanitation Permit# .:.... Date -) <br /> SepticTank (Specify Requirements). .............................................-................................................................................................. <br /> Disposal Field {Specify, Requirements) .-•-----------------------------•...........•------------------------------------------------------------•------....:.......,.....,... . <br /> i ________________________ _________________________________________________________________--__-------_-___-_-__:.._.._.-_.._...._..._:_..__...-______-___._._.._._.._.....__..-__.................._...... <br /> _ <br /> ..............."..-.---------------------------------- <br /> -----------------------_..__,__..___-_____________--.--«-..............------------------------------------- <br /> _---------------------------------------- <br /> )Draw existing and required addition on reverse side) <br /> 1 hereby certify that 1 haveprepared 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 focal Health.District. Home owner or llcen- <br /> sed agent; signature cert€ties Ilse 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 become subject to Workman's Compensation laws of California." <br /> Signed -------------•-------•-- ------- ........ ............... -- .............. Owner <br /> (�t Z e------- -- <br /> BY - 3itle -ed ----•-. ...... ............ <br /> (If other than-owner) <br /> FOR DEPARTMENT .USE ONLY <br /> APPLICATION ACCEP/TED, BY - -----------------------------=---------- DATE,_ <br /> BUILDINGPERMIT-fSSUED ------------= I-------------------•-•--------------..--..------- ............ -------DATE ------- ------------------------ ---------- <br /> ADDITIONAL COMMENTS ---------- ----•--- ........ ..................................... <br /> .......... ----- --------- : _ _. .... <br /> Final Inspection by- --------------- --_.,.. -....Date-Date _..'a..;�W. -. .. __....._..---.------- <br /> EH 13 .21 1-68 liev. 5M N JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />