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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> --------- --------- ----------- 7, 3 3Permit Nol <br /> (Complete in Triplicate) ------­ Z,, <br /> I-------- <br /> ------_-._---_-s-__--_--_-----_---_-------_----_-- This Permit Expires I 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. 549 nd existing Rules and Regulations: <br /> JOB 'ADDRESS/LOCATION _/--------- - ------- - ..................CENSUS TRACT ------------------------_ <br /> Owner's Name --- ----- ------------------- -------------------Phone <br /> ------------------------------------ <br /> Address --- X-1-- ----------- ---- --------------- --- ---- <br /> ------- city --------------------------------------------- <br /> :__.License # a��JM_7----- Phone k?Q i- <br /> ? <br /> Contractor's Name --; I - 4 <br /> Installation will serve, Residence [Apartment House-E] Commercial:F71TraiIer Court <br /> Motel F1 Other .j---'- +-----------------= ------ <br /> Number of living unifs:--.--/---- Number of bedrooms,-,3-.----Garbage Grinder --44Q 'Lot Size ___ _4-t.4 -___________________ <br /> Water Supply: Public System and name -------------------------------------- ------------------------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand'[:] Silt 0 Clay E] Peat E] Sandy-Loam E] Clay Loam <br /> Hardpan ] Adobe E] Fill Matericil--,---------- If yes, type.- ---------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, ,buildings, etc;..rnust be_placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within'200 feet,] <br /> PACKAGE TREATMENT SEPTIC TANK[ Size_._' Y12��_ V 4------------------ Liquid Depth -----tol-49--- <br /> GN <br /> Capacity Material No. Compartments -------------- <br /> Distance to nearest: Well ___Alle-------------- ------ Foundation ----/ ---------- Prop. Line --- -------- <br /> LEACHING LINE No. of Lines ----3-------- ------ Length of each line------e4eY------------ Total Length -------------- <br /> V Box/,JX4--- Type Filter Material _6K1R<Kbepth Filter Material ---J�-----------------------------­- <br /> ey <br /> Distance to nearest: Well ------------- Foundation _______le_-_______------------- Property Line --------------- <br /> SEEPAGE PIT Depth -------------------- Diameter ---------------- Number ----------------------------- Rock' Filled Yes E] No C] <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation --------------------)Prop. Line ----------- ...... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------------------------------- <br /> ----------------i-------------I--------------------------- <br /> Septic Tank (Specify Requirements) ----------------------------------------------------------------------------------- <br /> DiiposalField (Specify Requirements) ----------------------------------------------------------- ------------------------------- -------------------------•--------------- <br /> i <br /> ------------------------I--------------- <br /> -------------------------------------------------------------------------------------------------------------- --------------- ----------- - --------------------------------------------- <br /> ------­------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------i------- <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 /> he,l <br /> By 4- --------------------------------------------- Title -------------------------------------- <br /> - -------------------------- <br /> - <br /> other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----- ------------------------------------------------------------ DATE ----- ----------------- <br /> BUILDING PERMIT ISSUED --------------------------------------------------------------------------------------------------- ------DATE ------------------------------------------- <br /> ADDITIONAL COMMENTS - <br /> - ----- - ------------------- <br /> ----------------------------------------- _ <br /> -------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------- --------------------------------------------------------------------------------------------r------------------------------4�------ <br /> Final Inspection by: .--------- ---------------------------------------- -- - ---- ---- ----- ------Date ---- --—-2.72/-------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />