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FOR OFFICE USE: ' <br /> Cr "', FOR=.SANITATION PERMIT +� <br /> - - --------------•-------- ---- ------- APPLICATIPermit No:!--3_ c V_-l-_�_______ <br /> (Complete in Triplicate) <br /> ----------------------------------- <br /> 1 <br /> .......... <br /> - - ----I--- ---- ---------------- -------- This Permit Expires 1 Year From Date Issued Date Issued _��_-_o <br /> _ _ - --- <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 i ade i com dance it County Ordinance No. 549 and existing Rules.and Regulations: 1 <br /> JOB ADDRESS/LOCATION - - {7:S ° ---------------------CENSUS TRACT -------------•---•-------- <br /> Owner's Name <br /> - -------------------- -- --- : --- ----------------------------------- <br /> Address <br /> -.. ne -- <br /> --------------------•----•-- ---- <br /> Address - ` F <br /> City <br /> Contractors Name -------------------- ---------------- ------- ------------------------------.License # --------- ----- hone -------------_-------------- <br /> Installation will serve: - - ---Residence Apartment House,El <br /> Commercial ❑Trailer Court ; <br /> Motel ❑Other -------=----------------------------------- <br /> Water-Supp I .„Public S stem and name -------------- - - ------�----.�-Garbage Grinder----------- Lot�Size__.___________-__--------------------.---_-- _ <br /> Number f-hm unify------�- Number of bedrooms,' ----------�:- ------------------------•-•------•----------------------••--------Private ❑ <br /> g , <br /> Character of soil to a depth of feet: : Sand'❑ SiltE]4"' Clays ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> --Hardpan E] ______._---_ --_______ __ <br /> Adobe ❑ Fill Material If yes,type _ __________ <br /> i. � - <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,) 1 <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size------------------------------------------------- Liquid Depth -------------------------- <br /> Capacity <br /> ___--_----.__________ _Capacity --------------. Type -------------------- Material-------------- -Z,7---- No. Compartments ----------------.:..._ <br /> Distance to nearest: Well._'.---------------------------------Founclation _____________________ Prop. Line --------------..______ <br /> LEACHING LINE [ ) No. of Lines -------------------- Length of each line------------------ '...... <br /> __ Total Length -------------- <br /> --------------- <br /> d <br /> 'D' Box ------------ Type Filter'Material --------------------Depth Filter Material ----------------------------------- -------- <br /> Distance to nearest: Well _____,__________________ Foundation -------------------------- Property Line i <br /> SEEPAGE PIT [ ] Depth ____ ------------- Diameter ________________ Number ----------------------------- Rock Filled Yes ❑ No i❑ , <br /> Water Table Depth -------------------------------------------------Rock Size <br /> Distance to nearest: Well ________________________________________Foundation -------------------- Prop._Line,,, �. <br /> REPAIR/ADDITION{Prev. Sanitation Permit# -------------------------------------------- Date -------------- <br /> ----------- <br /> Septic Tank (Specify Requirements) ----------------------------------------- ------------------------- •-I-------- s .. <br /> Disposal Field (Specify Requirements) --- G �� <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: i <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 1,come ct t Workman's Compensation laws of California." <br /> Signed --- -------- ------ + ------------------------------------------ Owner <br /> -------------------------- Title ---=---------------------------------------------- <br /> ---------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --- ---- ----- ----------- ------------------------------------------------ ------------------ DATE = ------------ <br /> BUILDING PERMIT ISSUED - ---------- ------------- ----------------- ----A.-DATE _.---------------- --------------- <br /> ADDITIONAL COMMENTS ------------ __ .____ _ ___ <br /> -------- ------ -------------------- ----- ---- ---------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------- ---' ----------------= ---- --------- ---- -- ------------------- ------------------- �] ------ <br /> Final Inspection by: ---- --- `--------------- ------ -Date -5;--- ----�-�3 <br /> ------------------------------------------------------------- - -------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> fd1<yf '� <br /> E. H. 9 1-'68 Rev. 5M , <br />