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• FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ....... ...... ............... .......... {Complete in Triplicate) Per.mit. o. ... ... ........ <br /> ...................••-------............ <br /> Date Issued Z�IA.27 <br /> .......................... This Permit 9xpires I Year From Dow Issued, <br /> Application is hereby made to the San Joaquin Locol'Health District for a permit <br /> mit to construct and install the work herein <br /> described. This application is mode in compliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> JOB ADDRESS/LOCATION /_-...`.. ................CENSUS TRACT .0.4.0..... <br /> ....Phone <br /> Owner's Name ... .............. .......... . . <br /> d ....... / � <br /> ......... <br /> Address ..... . ...... City <br /> Contractor's Nome .4ocL ...s-e,.4�._ .........License # Phone ��.S_?_/O <br /> installation will serve: Residence4&Apartment House I-],Commerc:ial TfallerCourt 0 <br /> Motel Other )0M)/AVV,0;0r <br /> C I-ZI 4( <br /> C-Gorbage Grinder -AhVLot Size ......... <br /> Number of living units- Number of bedrooms;: <br /> Water Supply. Public System and name ........ ................................. ..........................................._ Private s, <br /> .........................Privot <br /> N <br /> i <br /> Character of soil to a depth of 3 feet: Sand T)d Silt 0 Clay E] Peat 0 Sandy Loom E3 Clay Loom 0 <br /> Hardpan Adobe [] Fill Material terial ............ 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,) <br /> PACKAGE TREATMENT SEPTIC TANK I I Size........4? .4s)..................... Liquid Depth ...................... <br /> Capacity o..CDType A.C-C927_ Compartments ..:2......... I <br /> Well ....da Foundation ..... ...... Prop. Line ..................... <br /> Distance to nearest: W ..................... / Ir <br /> LEACHING LINE [ ] No. of Lines ........1.............. Length of each line.........70............ Total Length .... .............. <br /> -D' Box ..../__._.. Type Filter Material ..?.,..:.......Depth Filter Material ... ..................... <br /> Distance to nearest. Well ....114Q.Ir ........... Foundation -------1 29 W-D..-13.a. Property Line ........... <br /> SEEPAGE PIT Depth .............. Diameter ................. Number ------__....... .......... Rock Filled Yes [3 No C) <br /> 0 <br /> Water Table Depth Rock Size .... ........................... <br /> Distance to nearest. Well .......................:................Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit 0 ............................................ Dote ....................... .......... <br /> SepticTank (Specify Requirements) .................... ------_------ _-----------_----------- ....... ---_---------------1........---------.................. <br /> Disposal Field (Specify Requirements) ....................................................... ................... ....... ._..---------............-•-----•..... <br /> .............................*..............*........................ ----------------------- ..................i... ............. ..................... ........... .......... <br /> ................................................ ....... .................................. .........................................­.................................................... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I ha4prepored this application and that the work will be done in accordance With Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of,the San Joaquin Local Health District. Home owner of licen- <br /> sed 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 subject to Workman's Compensation laws of-California. <br /> d <br /> Signed ...... Owner <br /> ............ ......... ........................ .......... <br /> ..... ............ <br /> BY ..... _aA ............................. litl ................... ...................... .......... ...... <br /> (if other than owner) <br /> FOR P&ARTMENT USE ONLY <br /> APPLICATION ACCEPTED By ...... ................ <br /> ................... DATE <br /> . . . .... ..... ................. <br /> BUILDING PERMIT ISSUED A ........................................... <br /> . . <br /> TE <br /> ADDITIONALCOMMENTS ........... ....................................................................................................—............... ............. <br /> -----------I....... .......................I........................ ................ .......................................... ....................... <br /> ......................... ........................ <br /> .............................. ..... ......... ............................................... ......................... .......................................... <br /> .................................. ... --- ...... ... <br /> ............. <br /> .......................................... ........................ <br /> Final Inspection by: . ....... �Ve ..................................................................Date <br /> JOAQUIN,-LOCAL HEALTH,DISTRICT <br /> s; U 13 241_-,&Q o_ n iA '7/723 x <br />