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FOR OFFICE USE:' APPLICATION <br /> SE:- <br /> APPLICATION FOR SANITATION PERMIT <br /> F (Complete in Triplicate) Permit No. <br /> ---- --- -- ------- ------------------------------------ <br /> - - ----------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued <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 /> elld_ <br /> JOB ADDRESS/LOCATION,r - .--- .1/-------- ✓' /�_/�--------------CENSUS TRACT <br /> i Owner's Name --- 1 - -----=-,;-- ----- -----=- -------Phone ----------------------------------- <br /> Address <br /> ----- -------------------Address ------------ City -m----------------------- --------- ---------------------------------------- <br /> Contractor's Name --------- T ------------------------ --------License # ---------:-------------- Phone -------------------------- <br /> Installation will serve: Residence ❑ Apartment House,❑ Commercial54Tralter Court ',❑ <br /> Motel ❑Other <br /> r <br /> Number of living units:__`_----- Number of bedrooms ---Y'------Garbage Grinder ---- -- -- Lot Size ------_---_-_-_ <br /> F - <br /> Water Supply: Public System and name ---------------------- ------ --------------------------------------------------------------------------------Private ❑ <br /> x Character of soil to a depth of 3 feet: Sand'E]. Silt❑ Clay [] Peat❑ Sandy Loam [J Clay Loam <br /> Hardpan ❑ Adobe ❑ Fill Material ___________ If yes,type ---------------------------- <br /> f Plot plan, showing size of lot, location of system in relation to welts, buildings, .etc. must be placed on reverse side.) p <br /> i' NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) N <br /> PACKAGE TREATMENT SEPTIC TANK Size- 6 <br /> f � ,,��'' � /��-f�� -------------•------------ Liquid Depth/�---------------•- <br /> I <br /> CapacityA _(5P__.___ Type/!' '_-__ Material-_a(Vlee_°--- No. Compartments _ -------------- <br /> Distance to nearest: Well -i_fah_-�____________________Foundation/` f______-_-__ Prop. Line ______-_______. `w <br /> 7 Total Length -0- -------------- <br /> 'D' <br /> - --------- w <br /> LEACHING LINE No. of Lines -__- Length of each lin//e_ -- '.-----_--.- g <br /> I D' Box A/17- Type Filter Material,,--,.,, r_Pr Depth Filter Material ._" "__-_____._ -------------- <br />' -,—Distance to nearest: Well ,ZPPr--_-______:Foundational - ------------- Property Line._._-----_.-___._.___�, <br /> SEEPAGE PIT [ ] Depth 4-..--.-.------- DiameterX_X_167'_'Number -------------------- Rock Filled Yes ,R No .C] <br /> i <br /> 114 X-,- be �Water Table Depth `-----------------------------------Rock Size /-I ff <br /> C Distance to nearest: Well - _f -f---------------------Foundation -.f9----------- <br /> Prop. Line -_ -____--_-____ <br /> 4 REPAIR/ADDITION(Prev. Sanitation Permit+ -------------------------------------------- Date ----------------------------------) <br /> SepticTank (Specify Requirements) --------------------------------------------------------------------------------------------------------------t..--------------------------- <br /> Disposal Field (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 become subject to Workman's Compensation laws of California." <br /> Signed ---------------- ---------- Owner <br /> B i �� <br /> Y ------------ �---------- <br /> ---- G-�-- �-�• ^- -- - - - -- - - ----------- Title ----- ' /�-P�j--=-------------------------------------- <br /> ot er than owner) <br /> r _ <br /> FOR DEPARTMENT USE ONL <br /> APPLICATION ACCEPTED BY -------------------------------------- - ----------------- ----- ---- ----' DATE ----- ------- -- <br /> - <br /> •�,� � <br /> BUILDING PERMIT ISSUED - - --------------- --- -- - --- --- --- DATE <br /> ADDITIONALCOMMENTS.--------------------------------------------------------- =----------------------------------------------------- --------------- ----------•---------------- <br /> ---------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------- <br /> I --- -------------------------------------------------------------------------------------------- ----------- ------ --- --- ------ ------- -------------------------- <br /> j -------------------- --------------------------- ----------------------------------------- ------- ------ ---- -- ----- ---- <br /> Final Inspection by: ----------------------------------------------------- ----- ---- Date -- �l_ ------ <br /> SAN JOAOUI AL HEALTH T <br /> b <br /> E. H. 9 1-'68 Rev. 5M <br />