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FOR OFFICE USE. <br /> APPLICATION FOR SANITATION PERMIT <br /> 7�. <br /> I(Complete In Triplicate) Permit No. ................. <br /> ...................... ......... ...... .............. <br />..................................................... This Permit Expires I Year From Dote.Issued Doti Issued <br /> Applicationis 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. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION i . <br /> ...CENSUS TRACT.. . .... . ............... ............. ...... <br /> Owner's Name <br /> ............................ <br /> A ..... __Phone -------------------------- <br /> Address . .......... CltyJ5�e�---------_--_---- <br /> .... - --------- <br /> Contractor's Name _ --------- License <br /> # one <br /> Installation will serve. ResidenceA,' ........Apartment House C] Commercialf:lTraller Court C1 <br /> Motel E]Other------------ ......................... ...... <br /> Number of living units_. <br /> /...-.- Number of bedroornscs......Garbage Grinder Lot Size'446X4&2�<.:------------- <br /> Water Supply:,Public System and name ..............................._------ ......... ......................... <br /> ................................Private <br /> Character of soil to a depth of 3 feet; Sand E]. silt 0 Clay 0 Peat 0 Sandy Loom' <br /> ❑ Clay Lou <br /> I MX <br /> Hardpan 0 Adobe 0 Fill lWaterial ............ If yes,tyP6............ Al <br /> ... ........ <br /> (Plottoon, showing size ;Dfi'lot, location of system In relation to wells, buildings, eft, must-be­placed-on-reverse side.) <br /> NEW INSTALLATION- <br /> (No�septic' tank or seepage pit permitted If public sewer Is available within 200 feet,} <br /> PACKAGE TREATMENT SEPTIC TANK I <br /> Size---------- ........ n..................... Liquid Depth .................... C' <br /> copacity� Type ...........i....... Material-_------------------- No. Compartments ------ ................ <br /> - - -------- --- <br /> Distance. to nearest:—WellJ . <br /> - <br /> ------------------------------------Foundation ...................... Prop. Line ...................... <br /> LEACHING LINE j j No. of Lines ......................... Length of each line.......•..................... Total Length ............................. <br /> 'D' Box ....... .... Type Filter Material ..______Depth Filter Material ..... ................................... A <br /> Distance to <br /> nearest: Well <br /> -------- <br /> --------------- Foundation ....... -----------_-- Property Line .............. <br /> SEEPAGE PIT DeOth� .............. -Diameter............. ..... Number ... _---------------_---- Rock Filled Yes ❑ No (37 <br /> Water Table Depth .................................. -.-Rock Size ....................I.............. <br /> Distonce to nearest. Well ---------- .............................Foundation ............... Prop. Line .... ................. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------------------------------- Date .—.............. ............4 <br /> Septic Tank {Specify Requirements),..... ..........................•... --. <br /> Disppso) Field (Specify Requiremenisl a-W.. ........ <br /> 2— <br /> . <br /> --------------------- ------------------------ ------------- --------?-------...........­­­............... ..................__..........i..................... <br /> i (Draw existing-and-required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work w.III be done In accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Hoalth,District. Home owner or licen- <br /> sed agents signature certifies the following- <br /> "I certify that in .the h' performance of the work for"which this permit Is Issued, I *hall not!employ any person'.In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ................ - --------- IV- <br /> ....... .......... ...... Owner <br /> By ----------------------- i, <br /> ----------- --------- <br /> e than owner) ----- 1..itle -------------------------- <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---(f,::--- <br /> _DATE <br /> BUILDINGPERMIT ISSUED '­ --------------- ...................................---------- ----------_---_---_----DATE .......................................... <br /> ADDITIONAL COMMENTS ......... ............. <br /> ----------------I-------------------11----- -------*1--------1­11-1-----------------I----------------I----------------------------- ---------------- --------- -------------- ------ <br /> ------------ ----------- ------- ------------I——--------------_.­-----------­----------- <br /> -----­------------ ...................1­...................... <br /> ...................... ......... % � I , \" �N <br /> ....................7 "Zi-------*................. <br /> Final Inspection by: ------ ----------------------------------------- --7-7. ..................... <br /> S_ ---------------------------------------------------•---------------•---.....--------....Date --------- ........ <br /> EH 13 24 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 31,E <br />