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FOR OFFICE USE: APPLICATION FOR SANITATION -PERMIT Permit No: -------- <br /> I-V ------------- ­ t. <br /> ------dow---- (complete in Triplicate) <br /> ------------ -------------------------------------------- This Permit Expires 1 Year From Date issued Date Issued --- <br /> _:--- --- <br /> A <br /> --- ----------------------------------j to construct and install the work herein <br /> Application is hereby made to the San Joaquin Local Health District for a permit <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations.. <br /> ------CENSUS TRACT -------------------------- <br /> -ATION ----- Xa . <br /> JOB ADDRESS/LOC - j----------- ----------------Phone :7K---- <br /> Owne ' -.4-�r"tpoAl <br /> Owner's Name ��vp_,5 ....�f, ----!------------------ <br /> city -------- <br /> Address --------_1R--V­3-------- - ------ <br /> "J_Phone <br /> ---- ------------T_ License 17 <br /> Contractor's Name S_ <br /> ,! �F� Commercial �[]Trailer Court 0 <br /> installation will'serve: Residence gg-Apartment House <br /> —----------------------------- <br /> Motel F1 Other ------;;? <br /> Q_c <br /> ----------- <br /> units:-.e;-Z-----iNumber of bedrooms ----Garbage Grinder --- Lot Size ------ ---- <br /> Number of living .1 ­­---------------­---'---------Private C] <br /> Water Supply.- Public System and name ---------------------- --------------------------------- <br /> Character of soil to a depth of 3 feet: Sand'Ej Silt El I 'Clay C1 • Peat 0 Sandy Loam -El Clay-Loam .0 <br /> I Hardpan 21 + Adobe-g�r—Fill Material ------------ if yes,type ---------------------------- <br /> locati.on of system in relation to wells, buildings, etc. must be placed on reverse side-1 <br /> (plot plan, showing <br /> size I&,' L available within 200 feet,) <br /> NEW INSTALLATION: I (No.septic tank or seepage pit permitted if public sewer is ava -------- <br /> L_� -1------------ Liquid Depth ------------ <br /> PACKAGE TREATMENT SEPTIC TANK:[ I Size------------------------------------ ---------- <br /> ---------- Capacity..: --------------- Type ------- -------- Material-------- -------------- No. Corr�partments ...... <br /> ---Foundation --------- ------------ Prop. Line --------- ------- <br /> LEACHING LINE No. of Lines - Length o <br /> Distance to nearest: Well ------------------I--------------- Total Length ------------ ---------------- <br /> ------------- --------- f each' line--"------------------ <br /> ------------------------- ------- <br /> 'I - ------Depth Filter Material -------------------------------- <br /> 'D' B X -------------: <br /> 0 ------ ----- Type Filter Material ....... <br /> I ----I------- Property Line ------------------ <br /> Distance to nearest. Well -------------- --------- Foundation _--------------------- Rock Filled yes C] No <br /> • <br /> 44 SEEPAGE PIT [ I Depth P------------- ------- Diameter ---------------- Number ---------------- <br /> Water Table Depth -------------------------------------------------Rock Size ----------------------------- <br /> Ion' "---------------- Prop. Line _.�----------­------ <br /> --Foundat' <br /> Distance to nearest: Well ---------------------------------- <br /> Date -------------------------- 1 <br /> (Prev. Sanitation Permit# ------------------------------------------- ,-- ----------­------- <br /> - I t � -- -------I------------------------------0-- ---- <br /> Septic Tank (Sp ecify Requirements) ------------------------------------------------------- ------------------ 41 <br /> r --- <br /> Disposal Field (Specify Re�uirements) ------------------ ------------------------ <br /> :.I ----------------- <br /> ------------------------------ <br /> --- <br /> i------------------------------------------------------------------ <br /> J--------- --------------------------------------------------------------------------------------------------------------------------------------I------ <br /> ------------- ------------------------ ----- ---- (Draw existing and required addition on reverse side) <br /> I hereby certify that ( have prepared this application and that the work will be'done in accorcla;ce with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations;f the Son Joaquin Local Health District. Home owner or ficen- <br /> sed agents signature certifies the following: ermit is issued, I shall not employ any person in such manner <br /> "I certify that in the performance of the work for which this p <br /> as to b subject Workman's Compensation laws of"California." <br /> .......... Owner <br /> Signed ........................................... <br /> Title --------------------------------------------------- --------------------- <br /> ------------------ <br /> By _------------------------------------------------ ------ ------------------- <br /> (if other than owner) - <br /> FOR DEPARTMENT U1 E f3NLY <br /> DATE <br /> APPLICATION ACCEPTED By ----------------------------------------DATE -- -------------------- <br /> ------T�?------ - --------------------- <br /> - -------------- ----------- <br /> BUILDING PERMIT ISSUED --- ---------------------------- -------------- --------------------------------- <br /> t ------------ ------- <br /> ADDITIONAL COMMENTS -----------------------------•- <br /> --------------------------- ----------- --- ------------------------------------------------------- <br /> ----------------------------------------------- ---- <br /> ---------------------------- -- <br /> Date <br /> ------------------------------ -------------------------- <br /> -------------- -------------------- --------------- ------------------------- <br /> ------- <br /> --------------------------------------- <br /> -------- - - ------ <br /> Final inspection by- ----------)ta <br /> SAN JOAQUIN LOCAL'' HEALTH DISTRICT <br /> t <br /> E. H. 9 1-'68 Rev. 5M. <br />