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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT <br /> ............................. Permit No. ..7�..- <br /> (Complete in Triplicate) <br />........ ...................... ................... <br /> Date Issued ..f: :7� <br />...••,••-----•-•-••••-••• •--I..................... This Permit Expires 1 Year from 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 a,pplicat�'.QQn is made in compliance with County_Ordinance No. 549 and existin Rules and Regulations. <br /> JOB ADDRESS/LOCATION <br /> ....-._.....•.------------.........................•-•.....................................................CEN US TRACT ......... <br /> Owner's Name ...................................................................:.....................P)tone.......-- ..................I.........`' <br /> Address ._. . 7.0 -- ------------ ._.._...._.... ........ City ._.....-------•-------...---..........---....................._...._. ...�... <br /> Contractor's Name -----------------------License # �- �- -- Pltone .,J�.... ��i[... <br /> Installation will serve: Residence 11 Apartment House Commercial❑Trailer Court 0 <br /> Motel ❑Other -------------------------------------------- <br /> Number <br /> -----•-----------------•---•----•--•---•-•Number of living Iunits:.-J•-------- Number of bedrooms ...�. ....Garloage Grinder ............ Lot Size ___ ...0 '. .........41�1% <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 1� ] <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,) y ,• <br /> 1.r i <br /> PACKAGE TREATMENT ] SEPTIC TANK( ] Size--- - -- ••� --------------- Liquid Depth ­V................. - <br /> Capacity 1•4•OP-----Type -- .......... Material.Z�--x!�....... No. Compartments ....6.t�............. <br /> Distance to nearest:.Well __. 9P........._...........Foundation ..I.. -.._.;....... Prop, Line ..,..Q._____... <br /> LEACHING LINE [ ] No. of Lines ____-�-:-- Length of each line........ j�l`.............'Total Length ._.�. ..._.__..._.. <br /> 'D' Box I------- Type Filter Material -_../ -.... Depth Filter Material ............................. <br /> Distance to nearest: Well .-...r•_.__":_:.":. Foundation ........................ Property Line ............4........... <br /> Foundation <br /> ! <br /> SEERA E•-PIT [ j Depth � _1jJOAJA Diameter --^................ Number .....®,�................ Rock Filled Yes j f No ❑ <br /> Water Table Depth . _.�_. _. ............... <br /> ...............:.......s.�_.__.:_...:..�_.. •.Rock Size�...... - <br /> Distance to nearest: Well ..._ l?...._.•............... Foundation .................... Prop. Line ...................... . <br /><t REPAIR/ADDITION(Prev. Sanitation Permit 9 <br /> r � <br /> ...... .................................... Date .: ................. ' <br /> SepticTank (Specify Requirements) -•.................. .............. ........................................ .......---"--•----....._..............._.. .._•-••-- <br /> Disposal Field_(Specify Requirements) .........:.........•-------.._..................----------------------._._...---..............------- <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 liven- <br />'` sed agents signature certifies the following: t <br /> "I certify that in the performance of the workfor which this permit is issued, 1 shall not employ any person in'such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> ... <br /> Signed - �-- ... - .. Owner r . <br /> By ....... ... ... .... ....... .. .Lt' . .. .- - - -.................I.......... Title ......._......................................__._................ <br /> ._.... <br /> if other han o ner) <br /> -FOR DEPARTMENT USE ONLY <br />' APPLICATION ACCEPTED •----•---•--•... ......................... DATE ............ <br /> BUILDING PERMIT ISSUED .............. ................................O 1�]?�I�. _..lf1� --••••--•----•----•---•-._.......DATE --------•--•--• .. -___..... . <br /> ADDITIONAL COMMENTS ...:1)!f?. JVVIlF. 4...Cf4, _-11�----GDRRF,��......L�RA • ••�_.:.... .I�----- <br /> ---- -- ----------------- <br /> =- <br /> ............................ <br /> .... .. •- -• . ....... <br /> . .... <br />% Final inspection by: ----•--.. . ...... ... .. . ............•-•................................................................. <br /> Date .. ..� �... .� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H.1.3 241.'68 Rev. 5M - --- __ 7/72 3 M <br />