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FOR'Offid USE:s p <br /> !s .• APPLICATION FOR SAN}TATION PERMITo <br /> ..... ...... Permit No. . ��..`.�G <br /> f IComplete In Triplicate) <br /> Date Issued . } <br />......................................................... . <br /> This Permit Expires 1 Year from Date kwed <br /> l the work herein <br /> Application is hereby made to the San Joaquin total Health u Dy �inana No.-5:49 a d existing Rules aand tnd Regulations, <br /> described. This application is made in compliance with Co Y <br /> CENSUS TRACT .......................... <br /> JOB ADDRESS/LOCATION - -• f/. , ...�.......:............ Phone <br /> Owner's Name ......... .......... ...................................--- <br /> Address moi ; ...... Phone •-.-----._... <br /> . ..... <br /> Contractor's Name do t ..........:........License 9ft ..:....._;..:.� ..- <br /> :... <br /> Installation will serve: Residence Apartment House t] Commercial ElTraller Court` 0 <br /> Motel Q Other ......................... <br /> ,. -"--�---•--..._ �'� Lot Size <br /> Number of bedrooms -2......Garbage Grinder <br /> . Number of living units:...�.,--- � .r <br /> . . ....._ <br /> Water Supply: Public System and name ...................•.. .....................................:......._.:..::................_.......... ate, . <br /> Peat O Sandy Loam Clay'LOOM 0 <br /> Character of soil to a depth of 3 feet: Sand'(] Slit Clay ❑ _ . <br /> Hardpan 0 Adobe 0 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. ,r <br /> w <br /> NEW INSTALLATION: (No septic tank or seepago pit permitted if public sewer 1`: liable within 200 fee# <br /> . <br /> Size'". ��.' �`. ...... qd Depth �.... , ...Q <br /> PACKAGE TREATMENT [ ] SEPTIC TANIG� -•. ,� :' ., Uut <br /> .,. .... <br /> ,� ,T. Material.44e) <br /> No. compartments :-fir........... <br /> Capacity/�O' ---- TYPOC�...... <br /> . <br /> Distance.to nearest: Well --- -• ................ <br /> ....Foundation ... e...... Prop. Line <br /> Imo. Length of Itner ............. Total Len th�.,, f `..._....... <br /> LEACHING LINE (x( No. of lines ... ......•.--• g 9 <br /> '©' Box fi Type Filter Material�� epth fitter Ma#erlal ..............•----::�-...� <br /> /. _ — . .�.:��--... � Property tine .6.-.,.�`•-T......... .,� <br /> ''" .. Foundation p <br /> l piston fio nearest: Wait ..��- $ <br /> `f ......... Number ....I............ . Rock Filled Y s g No 05 <br /> ... Diameter <br /> SEEPAGE PIT � Depth ..�- ••----- E <br /> F Water Table Depth ......... ........ ............ ..Rock size . ........ .. <br /> Distance to nearest: We ...,_40 . <br /> ...Foundation _.... e ... Prop. Line .. d-_.. _ p <br /> _ Date .......... .......: } <br /> REPAIR/ADDITION(Prev. Sanitation Permit - ... . <br /> r - .. <br /> .. ............. <br /> Septic Tank S eci Requirements) ..... ................... ,... <br /> Disposal Field (Specify Requirements( ......... ...... ............................................... <br /> ............ <br /> --------- ............... . l <br /> .............---.. ---------- <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 /> I County Ordinances, State Laws, and Rales and Regulations of the San Joaquin local Health,,District. Home Owner' or lian- <br /> sed agents signature certifies the following: '.' Y <br /> "I certify ihat in the performance of the work for'which this permit Is issued, I shalt not employ any person In such manner <br /> I as .to become subject to Workman's Compensation laws of California." <br /> ,y <br /> a <br /> Signed ---- .....-•............ .......... Owner <br /> B c J lila ~ :_..... <br /> ............... <br /> (if r t an owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED .BY .... .. =---- - --.- -- - •--•.............. DATE:,... _�.._._..:_..: <br /> BUILDING PERMIT ISSUED _.._...._. +-- - .............................................................DATE _...__. ....._...._....... <br /> ADi]iT10NAl COMMENTS ....»Ρ........................................ <br /> �_.!.......................................... <br /> ............., - - <br /> --- <br /> i.._ -•---•... <br /> Date . .... <br /> final Inspection b <br /> Eli 13 24 1-68 � V. jM � SAN JOA@UIN LOCAL H H DISTRICT 8/7l� 3M <br />