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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ---------------------------------------------------- <br /> (Completein Triplicate) Permit No. -.z.Z_.6-fl_-_. <br /> ---------- ------------------------- ------------------ <br /> ------------------------------------- - ------- This Permit Expires 1 Year From Date Issued' 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 application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOC ON _/9500 ;- ?,#----------- ----------------------------CENSUS TRACT -------------------------- <br /> Owner's Name - = _ -----.-Phone ------------------------------------ <br /> ----------- ----------------- <br /> Address p r� City <br /> Contractor's Name - -- -- ------------ � - ------.License # -�. 8.3-c�`2--Phone ------------------------------ <br /> Installation will serve: Residen of Apartment House❑ Commercial ❑Trailer Court I❑ <br /> Motel ❑ Other -------------------------------------------- <br /> Number of living units:------- Number of bedrooms -_3-----Garbage Grinder ------------ Lot Size ------ _---------. ----_-- i <br /> Water Supply: Public System and name -------------------------------------------------- -----------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt fl 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,) iA <br /> PACKAGE TREATMENT [ ] SEPTIC TANK:[ ] Size------------------------------------------------ Liquid Depth -------------------------- O <br /> Capacity -------------------- Type -------------------- Material---------------------- No. Compartments - O <br /> Distance to nearest: Well -----------------------------_---__Foundation ---------------------- Prop. Line ------------_------- <br /> LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length -----------,----------..-.-_ ` <br /> 'D' Box -------- --- Type Filter Material --------------------Depth Filter Material ------------- ------------------------------ <br /> Distance to nearest: Well ------------------------ Foundation ------------- ---------- Property Line -------------------- <br /> SEEPAGE PIT PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No ❑ <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------_ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------- ---.-------- Date ---------_-----------------------) <br /> Septic Tank (Specify Requirements) ----------------- - <br /> Disposal Field (Specify Requirements) ---- <br /> -----------------------1--,6-°- '----- - ----- - --------- --------------- ------- ------------- <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 /> 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 subjecf to Workman's Compensation laws of California." <br /> Signed --------------------------------------- - -- - - ------------- - -- Owner _ <br /> BY C Title 'u-e' �. <br /> (If other than owner) ------------ <br /> 0 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -_ ------------- DATE _J'30__-�-Z------.--------- <br /> - - -------------------------------------------------- <br /> BUILDING PERMIT ISSUED ------ -------------------------------------------------- ----- -DATE -------------------------------- ---- <br /> ADDITIONALCOMMENTS --------------------------------------------------------------------- ---- ----•- ------------- -------------------•----------------- <br /> ..----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------ <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------- <br /> ---------------------------- -- ---------- ---- <br /> p Y - j 5`- l v <br /> Final Inspection b .. _r 2- ` f�f Dates - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'6$ Rev. 5M <br />