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-' ' <br /> .OR OFFICE USE: <br /> APPLICATION-POR SANITATION PERMIT <br /> -0/7--------------------------- --------- t N <br /> Permit o. <br /> (Complete in Triplicate) ------------ <br /> ---------- -------------- -------------------------- <br /> ---------------------------------------------------------- This.Permlt Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Hea-lih-'�15ii-st Dist f6r '6' P'ehrhit 'to construct and install the work herein <br /> described. This application is macI6 in compliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> JOB ADDRESS/LOCATION ------------ --------------- -CENSUS TRACT ------------ <br /> -------------- <br /> Owner's Name ----- ---------- ----------------------- Phone _,.>x�_/ <br /> ]7 Address ------Z3 5-�C :S-•--------— - <br /> ---CT -------------------- City --- -------------_�-/ 4 0C 3 <br /> _5 <br /> _4 Contractor's Name --------License Phone �Z�------------------ <br /> Installation willserve. Residence <br /> ,kApartment Hous'e,E] Commercial ❑Trailer Court <br /> Motel E]Other <br /> Number of'I iving.'A its:-Supply. Public and Numbe-r of bems -.7------Garbage Grinder ------------ Lot Size --- <br /> 'd' r- <br /> y <br /> Water risme ----------- • -- ------ ------------------Private E] <br /> Character of soil to a depth of 3 feet: Sand'E] Silt E] Clay El Peat El Sandy Loam -E] Clay-Loam f-] <br /> Hardpan E] Adobe f 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 /> I r <br /> NEW INSTALLATION: (No septic tan age pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ri"IPTIC T_V Size----------------------------- - ----------- Liquid Depth -------------------------- -- <br /> Capacity�:- -- ------------- Type ------------------'-- Material--------------. -------- No. Compartments ----------------------- <br /> Distance to nearest: Well ------------r------- k <br /> -----------------Foundation .11------------------ Prop, Line .----------el--------- <br /> LEACHING LINE 'No'—of'LinOt -------/----------- Length of each line 7 <br /> I . ----- --- ------ Total Length <br /> 'D' Box Type Filter Material ----Depth Filter Material ----- -----------I----------- <br /> V1 <br /> Distance to nearest: Well �A_ Foundation -------- Property Line ---- —--------­----- <br /> SEEPAGE PIT Depth ----- Diameter --------- Numbe, -------i-------- Rock Filled Yes No C]C) <br /> Water Table Depth -------- C ----Rock Si e ----I�P_ ---- <br /> "?/0----------- ----- ----------- <br /> }"t 1� Distance <br /> ---------- <br /> Distance to nearest: Well Prop. Lin <br /> ---------------------Foundation - ----------------- e .............. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------ ------------ Date --------------,-t-___---_--_--•---) } <br /> A - -----------,-t------------ <br /> pticTank (SPecifyRe ------- - <br /> quirements) ------ <br /> ------------ <br /> - --- <br /> -- <br /> ----------------------------------- <br /> Disposal Field (Specify Requirerhents) -------- ....... <br /> -------------------------------------------------------------- ------------j__ <br /> ------------------------------------------------------- --------------------------------------- <br /> ---------------------------"I------------- ----------------------le----------- --------------------- ----- <br /> .4 ------------------------------------------------------------ <br /> ------------- <br /> Mraw existing and required addition on reverse side) <br /> I hereby certify that 11,,have prepanid_ this application and that the work will be done in accordance with Son Joaquin <br /> County Ordinaric"e4i, §tote Laws, and Rules and Regulations of the San Joaquin Local Health District. H"e owner or flcon-' <br /> sed agents signature certifies the foll4wing: <br /> "I certify that in the peirformance of the work for which this permit is issued, I-shall not employ any person in such manner" <br /> as to become subject.to Vorkman's Compensation laws of California." <br /> Signed --- <br /> ----------------- --------------------------. Owner <br /> ----------- ------------------------- <br /> By ........ ------------------- Title - ----- --- ---------------------------------- ----------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> BUILDING PERMIT ISSUED --------- ------------------------------ DATE ------------------ <br /> F ----------------------------------------------------------------DATE <br /> ADDITIONAL COMMENTS <br /> ------------------------------------------------------------- -------------------- ------------------------------------- <br /> -------------- - --------------------------- -------------- ------------------------------------------------------------------------------------ <br /> --------------------------- ------------- ---------------------------------------------------------------------------------------------------- <br /> --------------- - 1. <br /> ------------------------------------------------------------ -------------------- <br /> pection by: ---------------------- -- ------------ <br /> �` i <br /> Ins �_A ---------- - ------ ---------------------------------------- ------------------------------------- Date ---- ---------- <br /> J SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M. <br />