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FOR OFFICE USE � <br /> .............. . j1..r.. APPLICATION FOR SANITATION PERMIT <br /> tCompleh in Triplicate) <br /> - <br /> -------------- --- --- ............................... This Permit Expires 1 Year From Dote Issued .`Date Issued .. 5.� •,7� <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 npde in compliance with County Ordinance Na. 5' 9 and existing Rules and Regulations: <br /> i <br /> I JOB ADDRESS/LOCATION ..... . __.-7-__-/ -••• . �s .•• ..•. ... .. ..•CENSLIS TRACT ....... <br /> G Owner's Name .., � <br /> r ................... <br /> 1--�f .� �. .fc� ....:................... <br /> Ph� ne <br /> Address . .�•-� Ct1t_ ._ •c1 .................... <br /> 0 <br /> 3 "Z .................... ..... City . Azt,J <br /> :..... •------ <br /> Contractor's Name .-- �,�-T- <br /> ,.��"cc�tE'� _ c-Al..--•...License 9}` t7..3Phone . 1���__-: 1 � <br /> Residence XApartment HouseInstallation will serve: <br /> I-] Commercial{]Trailer Court o <br /> k Motel <br /> � (]Other---------------------------------•--- • - - <br /> Number of living <br /> units:..../---- Num� ber of bedrooms -,Z•�Garbage Grinder <br /> . ...__ lot Size ......�.4-•�.�.1.?�. <br /> Water Supply: Public System and name Q <br /> .. -.. Private <br /> _.. •............................ <br /> Character of soil to a depth of 3 feet: Sand E] Silt❑ Clay ir Peat 0 Sandy Loam 0 Clay-Loam Q <br /> Hardpan Q Adobe Fill Material ............ if yes,type <br /> .............. ............ <br /> (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: IN* septic tank or seepage pit permitted if public sewer is available within 200 feet,) Y <br /> PACKAGE TREATMENT I ) SEPTIC TANK <br /> 7 Size.------�X---�.. ..... .............. Liquid Depth <br /> yp � .$'MaterialCompartments <br /> . _ <br /> Capacity _l.�Q� Type � ••__....... <br /> ---/' <br /> �-f3�- �dJo. Compo menta ...................... � <br /> .J <br /> Distance.to nearest: Well <br /> : ..h''-?�- -------- <br /> ----- .Foundation t4..---..... Prop. line ....�r.......r <br /> LEACHING LINE <br /> [ ] No. of lines -------- -----•------- Length of each Zine----1 _ ..`..._...-• Total Length .._1--0 ......... <br /> 'D' Box �� >- Type Filter Material ...� K.9..Depth Filter Material ....� <br /> Distance to nearest: Well ---..... Foundation _._/.�].............. Property Line ... �..`....... <br /> SEEPAGE PIT �__.....___ Rock Filled YeP___140 <br /> _,..�.`. I 1 Depth ._ Diameter .. .. Number s Lr No <br /> k <br /> Water Table Depth _------ -�---- - Rock Size _ .1L <br /> Distance to nearest: Well 00 f V, <br /> 1� - --�...-•---•--.Foundation .Zj0._:......_ Prop. Line I <br /> . I <br /> REPAIR/ADDITION(Prev. Sanitation Permit�k ................... . . <br /> - - -•--------•-•-------- Date ..................... <br /> Septic Tank (Specify Requirements) .............. <br /> Disposal Field {Specify Require ...... ............................... --• <br /> ments) <br /> -------•-- ------••---_---••-•-----. _------ ------------•------••-......_•----•.......-- <br /> ..------- ------------------ <br /> (Drawexistin and r __-...-•-------------•-......_.........•.-•--•........-- <br /> g quired addit€on on reverse side) - ' <br /> I hereby certify that I have prepared 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 Lova) Health:Dlstrlct. Home owner or liven. <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 Iseco s jec to Werk an's ompensation laws of California." <br /> Signed ------ -- `---------- Owner <br /> : . Sitle _... <br /> By ...-.. <br /> (If other than ownerl <br /> FOR DEPAR MENT USE ONLY ' <br /> APPLICATION ACCEPTED BY _ <br /> ----•---•--• •-•-- -------------------------------------------- DATE <br /> BUILDING PERMIT ISSUED ____________ <br /> ADDITIONAL COMMENTS _._..._.._ ...�'....-._ _ - DATE <br /> = r - - -- -•�...................... ....... <br /> ..__...----•-•.................... <br /> ----------- ---.. <br /> ---•---------•..................... . <br /> -- - • ----- ---- -- •---•-•------••--••----•--•••--• •----•---------•- ------- ---• !� <br /> Final Inspection by: ..._.__._•----------_ •-- - _ <br /> EH 13 2h 1-68 Rev. 5'q `.............. .. ..... ... .. <br /> SAN JOA UIN LOCAL HEALTH DISTRICT 8/7h 3M <br />