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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> - -------------------------------------------,.-- - Permit No. _`7_�- <br /> (Complete in Triplicate) -- ------ <br /> __.________________ ______ This Permit Expires f Year From Date Issued Date Issued ---1__ .__"------ <br /> Application is hereby made to the San Joaquin Local Health District for a per 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/LO ATION . .------ --------------- ----------------- - -------------------- ------CENSUS TRACT ------- ------------------ <br /> Owner's Name __ __ -_ <br /> OE <br /> Address Os c cam?44 --- °�T------------------- Cit <br /> Contractor's Name - ------------------------------------------------License # --------- -------------- Phone ----------.-----------........ <br /> Installation will serve: (� Residence eApartment House ❑ Commercial ❑Trailer Court ',❑ <br /> Motel ❑Other -------------------------------------------- <br /> Number of living units:---------- Number of bedrooms _________ __ arba Grinder ------------ Lot Size ___S©--X 1 s l ____________t `_: ty u <br /> Water Supply: Public System and name _ ___ _ __ _�__ ____-_____ �----------A <br /> _ ___________________Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ 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 pe}rmitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [`� /`J<�G� ize_____ _,�'___ /_�-._,S_��1-_.__._.__ Liquid Depth ______L1_ _,____ <br /> ;�nr n j' Capacity _� 1�_______ Typ __Y----_CK5`; aterial_f_-ao_.C__`---- No. Compartments - �..._ <br /> Distance to nearest: Wel -----------{ <br /> I --�J�--1�1�-------------Foundations �-dProp. Lin�:.-�--f••----•---' <br /> LEACHING LINE: [�ij' No. of Lines --------_ ______________ Length gf each line_____ _-�_(�______-____ Total Length _____ __L�1 U_____________ <br /> / / <br /> D' Box ------------ Type Filter Material _ _=1__________Depth Filter Material ______!___ <br /> Distance to nearest: Well --- ---------------- Foundation ----/6--* Property Line ______I ._ __________ <br /> SEEPAGE PIT [k( Depth ---I6'I------- Diameter ,,?4�-_lel--- Number ---------`----------------- Rock Filled Yes No <br /> / ❑ <br /> Water Table Depth ------ _Rock Size -7bk 77 <br /> ` <br /> r <br /> Distance to nearest: Well ----�10 ----------------------Foundation ----/0-_--._____ Prop. Line _____ ....... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _________________________________ _ Date -------- ------------------------- <br /> Septic Tank {Specify Requirements) - -- -- --------------------- --------------------------------------------------------.._--------------------------- <br /> DisposalField {Specify Requirements) --- --- --------------------------------------------------------------------------------------------------------------------------- <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: <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 be o bled"to rkmon' mpegsati.on laws of California." <br /> Signed - ------- ------------- Owner <br /> BY --------------- -------------------------------------------- ----------------------------------------- Title --------- ------------------ ------- <br /> (If other than owner) <br /> O ROARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------ ----- -- ---------------------- DATE -------_Q'= y'r/y�-----------.. <br /> BUILDING PERMIT ISSUED S = DATE / / <br /> --------------------------- -- <br /> ADDITfONALCOMMENTS -- ----------- ------ - ------------------------------------------------------------------------ ----------•---------------- <br /> -------- --------------------------------------- - - ---/JOAQUIN <br /> - --------------------------------------------------------------- ------ y—� =------- <br /> Final Inspection by: ----------------- ----------Date __' ,----------- -------------- <br /> LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />