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r FOR OFFICE USE: V <br /> APPLICATION FOR SANITATION •PERMIT <br /> {Complete in"TripfIcatel - �" _. _ _PermitNo. _T ,________.` <br /> ------------------- - ----------------------------------- <br /> 7----------- <br /> This Permit Expires ] Year From Date Issued 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. 349 and existing Rules and Regulations: <br /> # JOB ADDRESS/LOCATION � _ Sil ------------------------------l� <br /> F ' --- CENSUS TRACT --•-----------••-----•---- <br /> -------------- <br /> Owner's Name ---i -- ------ 9 - ------- Phone <br /> I Address ---- -%/}-p �` �I . <br /> - City - <br /> License # 02� �_7__ Phone <br /> ' x � <br /> i <br /> Contractor's Name _-'��' - -- ---� a2c-c- -- ----- - ---------- ]--- <br /> Installation will serve:•;—._._r-Residence ['Apartment Housw❑ Commercial::❑Trailer Court ',❑ <br /> M <br /> ......TMotel ❑ Other-_--___------- <br /> ---------------------- <br /> Number of living units:---_----- Numbertof bedrooms __,_____Garbage Grinder ------------ Lot Size ------I--- ._______________ <br /> Water Supply: Public System and name `----------------------------------------------------------------------------------------------------- =Private Xr <br /> Cha acter of soil to a depth of 3 feet: Sand;❑W Silt-(3 - Clay-.E]--Peat E]-�- -Sandy-L•oam O-C-Iay-Loam <br /> j� Pardp ❑ Adobe ❑ Fill Material ------------ If yes, type ---------------------------- <br /> (Plot;plan, showing--size of-IW loc Pf ion of)system in relation to wells, Buildings, etc, must be placed on reverse side.) NA <br /> NEW INSTALLATION:, {No septic t6 nk or seepage pit permitted if public sewer is available within 200 feet,) v <br /> PACKAGE TREATMENT [ 3 SEPTIC TANK, t] Size------------------------------------------------- Liquid Depth ----------------- --------- <br /> F i Capacity _��_�.�___ ° Type -, _ Material---I No. Compartments ____ ........ <br /> ~ Distance tw nearest! Well _________ 0_d----------------Foundation ------- -------- Prop. Line ._-.ate.. _....... <br /> LEACHING LINE [ ]' No, of Lines ---- . __________-- Length of each line-____��1._6------_______ Total Length -_•-__-- <br /> 'D' Box -----j------ TYPO e Filter Material -------------------Depth Filter Material ----------_--------------------------------- <br /> Distance to ,nearest: Well -----/b_a--------- Foundation -------1 q----------- Property Line _______ _______________ <br /> SEEPAGE PIT { ] Depth ------- ------------ --------------- <br /> (Diameter _ Number __________________________ Rock Filled Yes ❑ No 0 <br /> i c � <br /> Water Table Depth --------------------------------------------------Rock Size --------------------- -•---- <br /> I Distance to nearest: Well _ ___________________________Foundation -------------------- Prop. Line ...................... <br /> I REPAIR/ADDITION(Prev. Sanitation Permit#I-______ ___________________________________ Date ___________ ____] <br /> ,. fl <br /> Septic Tank (Specify Requirements) t------------ -----------------------------------------------------------------•- <br /> t Disposal Field (Specify Requirements) ---- ------ ----------------------------- ----------------------------------------------------•--------------- <br /> ------- --- <br /> Y E <br /> ----- -- ------------------------------------------------------------------------------------------------------------------------------ <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that f have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and RuI se 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 subiect to Workman's Compensation laws of California." <br /> Signe�d�------------------------------------------------------------------------------------------------- Owner <br /> BY lN�'-• /an <br /> � ------------------------ Title ----------------------------------------------------------- <br /> I (if other owner] <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------ 6WA DATE ...4;�:.4�1'2-------------------- <br /> BUILDING PERMIT ISSUED -----------------------------------------------------------------------------------------------DATE ------------------------------------------- <br /> ADDITIONAL COMMENTS -------------`---------------------- ---------------------------- <br /> 1- ------------------------------------------------------------------------------------ -----------------------------------------------------=-------------------------------------------- <br /> --------f---------------------------------- ------------------------------------------------------------ -----------------------------------------------------------------'--------- <br /> ----------------------------------- <br /> -------------- <br /> Final'Inspection by: ----------- �eG� �� _»_- Date _.__ 7 ---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> .. H. 9 1-'68 Rev. 5 <br />