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FOR OFFICE USE: �Z� <br /> APPLICATION FOR SANITATION PERMIT sx ' <br /> ..... ..... . .............. .- T Permit No.�/:- .7�i' <br /> (Complete in Triplicate) <br />,. This Permit Expires 1 Year From Date Issued <br /> Date Issued .F-,�9'.? <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 <br /> isting Rules and Regulations: <br /> JOB ADDRESSJLQCATI N ......�. ,� E`?..v.` :. ..��......0 NSUS TRACT ............... .....>-.�... <br /> Owner's Name ....... 4a44.1.. CO c�!?�............. // ..Phone <br /> Address .-.. _.�1'�....................................... City .,4� ,�..............._.............................. <br /> �* <br /> Contractor's Name ............... . . <br /> l� ....License # ........................ Phone .............................. <br /> ......�.. . ... . . : <br /> Installation will serve: Residence Apartment House❑ Commercial [:]Trailer Court 0 <br /> Motel ❑Other ---------------------------- ------------•-_ <br /> Number of living units:... .... Number of bedrooms -_..:Z...Garbage Grinder ............ Lot Size -------------------------------------------- <br /> Water Supply: Public System and name .............. ..........................•----•------------...............-......--•---...---.........:.......Private ❑ <br /> Character of Boit io_a-depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam�] <br /> Hardpan ❑ Adobe❑ 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 seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK-[ ] Size................................................ Liquid Depth ..........................W <br /> Capacity .................... Type ..................... Material.......... ........... No. Compartments ...................... %P <br /> Distance to nearest: Well ....................................Foundation ...................... Prop. Line ...................... 0 <br /> LEACHING LINE [ j No. of Lines ........................ Length of each line............................. Total Length ............................ V) <br /> 'D' Box ...... ..... Type Filter Material ....................Depth Filter Material ............................................ <br /> Distance to nearest: Well ........................ Foundation ........................ Property Line ........................ <br /> SEEPAGE PIT Depth ❑ ❑� <br /> [ ) p .................... Diameter ....._.......... Number ...---.........._......._... Rock Filled Yes No <br /> Water Table Depth .............Rock Size '} <br /> Distance to nearest: Well........................................Foundation .................... Prop. Line -..........._.-.....� <br /> I REPAIR/ADDITION(Prev. Sanitation Permi # .. ............ •--,,__�__ D ite ............. ....................) <br /> Septic Tank (Specify Requirements) .. <br /> Disposal Field (Specify Requirements) ____--./ = -•---•-••--c-- -•- -'•� ••S `��1 { ------ G <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, I shall not employ any person in such manner <br /> as to become s�A1ect to Workman's Compensation laws of California." <br /> Signed �.".�'-� <br /> `-"_----...._•-_•...................... Owner ✓` <br /> By ....- . ..............•----..........---.......------....------...............................•.-.. Title .........................................._.......................... <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ......... - -• •• .................... •••-••........----••---•............. DATE .... ............. <br /> BUILDINGPERMIT ISSUED ..........................................................................................................DATE ........................................... <br /> ADDITIONALCOMMENTS ............................................................_....._.t...._..................................--•--.................:...._.......----.....---.•• <br /> ............................................................................................•--------•--•------•-.........................................---...-----..................._................ <br /> ..................................................._..._. ..... :.... :.............._............ <br /> ........................................ ... . r................................................... _ <br /> Final Inspection by. ................ . _ ----------------------------- <br /> SAN <br /> .--- Date ...rte. .' .Y......._.... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H.13 241-'68 Rev. 5M 7/723 ,14 <br />