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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> - - <br /> (Complete In Triplicate) Permit No. ..7._.'.._.�: <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/LOCATION ........if 3._ 03;_:_._ _ °_�� 4.y ..:.................. <br /> _ ............................CENSUS TRACT ..:....... ......... <br /> Owner's Name <br /> ............................. <br /> �.. .g:�. �.���.�----------------------..........................:............Phone ....�7.�.�.-S�;t•3. <br /> Address _..[. �?O e-fio '....................................... City - LQOJ,..-------•-....._.._.............:........................ <br /> U------ - <br /> Contractor's Name License # .. .... 5' -Phone <br /> Installation will serve: Residence I&Apartment House❑ Commercial ❑Trailer Court 0 <br /> Motel ❑Other ........... ----• <br /> Number of living units:............ Number of bedrooms _.3......Garbage Grinder ------------ Lot Size <br /> Water Supply: Public System and name ...............................................................................................................Private [� <br /> Character of soil to a depth of 3 feet: Sand 0 ..Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 � <br /> Hardpan C Adobe.I] Fill Material ....___: ... If yes,type.------------------------- -- <br /> (Plot plan, showing size of lot, location of. system €n relation to wells, buildings, etc. must be placed on reverse side.) <br /> IN <br /> NEW INSTALLATION: INo septic tank or seepage pit permitted ,)if public sewer is available within 200 feetQ <br /> PACKAGE TREATMENT SEPTIC TANK Size................ ............:... Liquid Depth --- ...................... <br /> Capacity .................... Type .................... Material---------------------- No. Compartments -----...._............ <br /> t -4 <br /> lstance to nearest: Well ....................................Foundation ...................... Prop. Line _.____......... ...... t <br /> LEACHING LINE iNol of Lines`------ ..... Length of each line---------------------------- Total Length y; ............................ <br /> D' Box ............--Type`F€Iter Material :`..' L .......Depth Filter Material .........................:.............. <br /> :-•- <br /> Distance to nearest: Well .................:...... Foundation`.................... Property Line ...:.:........... ...... <br /> SEEPAGE PIT ( 7 r> Depth -------------------- Diameter ._........... Number ............................ Rock-filled Yes,❑ No o <br /> JWater Table Depth .. ............................. .............Rock Size ................................ I <br /> . f •pl k <br /> Distance to nearest: Well . <br /> ---•--'----••-------•-------•---------..,Foundation --------------------•-Prop..�Line ....---• ----...--•--- <br /> REPAIR/ADDITION(Prey: Sanitation Permit.# -.0-Z k-Y......_4._.--..... Date ..7.`.��:.�.�....., ) <br /> SepticTank (Specify`Requirements) --------------------............................................................•---•............ ...._....,.._..._.._. .._........------... <br /> Disposal Field (Specify Requirements) --ffiA_d___-L(.'3�::. ------------=-- <br /> /F— ", ►.r?. ---..S.�,Js "'-e vv---------------"-..-- - ------...._ . . -- <br /> ..............._...__._._.:_.__.....................--•-------------------------------•------------•------•-•---------------- --------- ------------­-- ...........I....... <br /> ..._.. <br /> r_. .(Draw existing.and.re uired.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'licew <br /> sed agents signature certifies the followings <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 sublet o orkman's Compensation laws of California." <br /> p <br /> Signed .- = _l �'1.r ..................... Owner <br /> BY . ---------------------- ............................ ........................ Title -----------•------ <br /> Ilf other than owner) <br /> fOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .. . .. .. ... <br /> ........... DATE ..... <br /> BUILDING PERMIT ISSUED ................... --•-•------••----............. ............DATE ........................................... <br /> ADDITIONAL COMMENTS ....................•..:.................................................. <br /> .........................................................:..................--------- ) <br /> -------------------------------•--- ....__ . _._ ........_.t..... ---•--- <br /> Final Inspection b . ..... I.................---Date .. . . ~7 -------- <br /> _. .SAN,JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H.3-3 24 1.'68 Rev. 5M 7/72 3 <br />