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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT � <br /> _.._. Permit No. .7`3... 5. <br /> (Complete in Triplicate) <br /> _.......... �. <br />..................... ....... This Permit Expires 1 Year From Date issued <br /> 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. 544 and existing Rules and Regulations: ! <br /> JOB ADDRESS/LOCATI N .......... .�_�......_..�.r____.. • • } <br /> �1.�.:.�.................CEN5U5 TRACT ...:.._.__..._.... <br /> Owner's Name .... .. ... . .......... I --....... <br /> hone ..1�..�a..�... _..�./•. <br /> Address ----- .................. <br /> •................ City ... .. <br /> Contractor's Name .... ,�...�� . . _ ._.....License #o� r`lf7'�. Phone <br /> Installation will serve: Residence ❑Apartment House❑ Commercial '❑Traller Court ❑ <br /> Motel ❑Other ............................................ <br /> Number of living units:___ ....-_._ Number of bedrooms _c_.....Garbage <br /> Grinder Lot Size ...... .t ------J_//�....__.J_//(?*�.... <br /> Water Supply: Public System and name -----,.� �." 1�............................. ............................• C1.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 perrryitted if public sewer is available within 200 feet,) l <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ j ! Sa .......... ...................................-------- Liquid Depth ........... •......••••... <br /> Capacity .................... Type . ............... Material------ ............... No. Compartments .................... <br /> Distance to nearest: Well ....................................Foundation ...._...............__ Prop. Line :.................... V s <br /> LEACHING LINE No. of Lii�nerrs��...... ------------- Length of each line..._.��----_......... Total Length .. P................. <br /> 'D' Box .'t7T__ Type Filter Material ------Depth Filter Material ...4 .....................I...... <br /> __._ <br /> Distance to nearest: Well Foundation ---------- Property Line ........ <br /> SEEPAGE PIT 9Depth .. -_.._.. Diameter -3,T----- Number -------/................ Rock Filled Yes J No ❑ (� <br /> Water Table Depth ..Q' v� i <br /> -------- - ------------•----•--......._.....Roc Size ..............---••�----------- r'• ,, <br /> Distance to nearest: Well .................. .........Foundation ------� .._.... Prop. Line ._�._............. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................. <br /> Requirements) <br /> t/ Date ...............:........_____----_ <br /> ---------- <br /> Septic <br /> (Specify <br /> .. ------• .... ........................ <br /> _.. <br /> --------- <br /> Disposal Feld I5PcfY Requiementsl � .--._.. ---L.c. =�� <br /> j; <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 i <br /> as to became subject to Workman's Compensation laws of California." <br /> Signed .............. Owner <br /> BY ..... ........ .�a�._..... - ................... Title ........ <br /> (If other than owner) i <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --VKI . .. ..• ------------•--•---•-•............ . .......:............................. DATE --_... 1;?A.1.73................... <br /> BUILDING PERMIT ISSUED ..... ............................. <br /> :-- ---------------------- <br /> ----------------•--.-.......... ...DATE ........................................... <br /> ADDITIONAL COMMENTS ............. <br /> .... ................................•-----•------------..-------.................................. <br /> ....... <br /> :.--•-•-.................... <br /> ............ ...... -•-•------•-=--••-------------•-•--.............................-----....................... <br /> p.ti}X � ... _jd� ............................. .....__.-__..___..... ...._ ---___-___-_..___..__.. f <br /> .................................''-_. -. ... ... <br /> Final Inspection by: _._....">ry ........__ -...... .Date .. .. -'�............... <br /> .. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> r u 13 24 1_-An o_ r►. 7 I79 1 u <br />