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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT of 3 <br /> ------- ^......................I... Permit No. ..................... <br /> ICompleto in Triplicate) <br /> ----------..........I................. .......a.... w. <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--36.P -/.... .- f E' .....................................CENSUS TRACT .......................... <br /> Owner's Name ..... /I/el -�---------------•--_-:-------------•• ................. ................Phone ...... ......_...................... <br /> Address ..... 1.. � / CityContractor's Name _--NA <br /> Q.. �_.... License #�71�- �. Phone .s�.`.o% <br /> ------. .....--••••••--•- <br /> Installation will serve: Residence artment House C] Commercial QTrailer Court J] <br /> Motel ❑Other -------------------------- <br /> 'Number of'living units:_:._"" C Number of be moms _�_____Garba a Grinder �G.... Lot Size:��._.. f� <br /> 9 ..............I............... <br /> Water Supply: Public System and name _... _ ---.....� ..............................................................Private Q <br /> Character of soil to a depth of 3 feet: Sand 0 lilt❑ Clay Peat Q Sandy Loam ❑ Clay loam ❑ <br /> Hardpan ❑ Adobeo 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,I <br /> PACKAGE TREATMENT [ l SEPTIC TANK f j Size........ .....:................................. Liquid Depth .......................... <br /> Capacity -- Type •................... Material...................... No. Compartments ...................... W <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 [ 1 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 ..........e:.:.. .............. C <br /> Septic Tank (Specify Requirements) ----------------------------------- ...................................... -•-----•--- .....••. .... <br /> Disposal Field (Specify Requirements) .---•__-. _ _ frr:---._ ... ..�_ r.�!'`•------ --- ------- --G4!`'' /'.._.--------------- <br /> Y .._.. , --------- _----- ------------------------ <br /> --------------------------- <br /> •--------------------- <br /> ------------------------------�--------- .--------__._-----------------------------------------------------------............................................. <br /> (Draw�existin and required addition on reverse side) <br /> Chereby certify that 1 have prepared this application and that the work will be stone In accordance with Sem Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,Dlstricf. Nonce owner or licen- <br /> sed agents signature certifies the following: Y <br /> 111 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 subject to Workman's Compensation laws o California." <br /> Signed ------- ---- ------- - Owner <br /> 4 <br /> BY ............ ---- ...----- . Tit#e .... �r� .... <br /> ----.... --• --- <br /> ... <br /> other than owner) <br /> FOR 9PARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY r •---- -------------- -------------- DATE ------- <br /> BUILDING PERMIT ISSUED " •...............•------- --------------------.DATE -------------------------------- ---------- <br /> ADDITIONAL COMMENTS .................................... -------- --------------- .% <br /> f 3 <br /> ..-------------.---.----------------.------.-------------------------------------- <br /> --------------------._--_--.--._..__...__.-..._..__.-_-----..-.............._.._...__...-..............-.......- . <br /> ....................................... --- <br /> .--_----•- -- - --------------------- --------------------------------------------- ............ ............ <br /> ----------------------------- ------------------ ---- ----- ------------- ---------------------------------------------------------------------------� ...... <br /> #anal Inspection b : . --- --------- ----------------.---•------------------------- ------...Date . ......... <br /> E 13 2}� 1-6(3' ftev' 59 SAN JOAQUIN LOCA. HEALTH DISTRICT 8/7� <br />