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FOR OFFICE USE: <br /> APPLICATION FOR. SANITATION PERMIT - <br /> .�,.., ............... . (Complete in Triplicate) ermitMN <br /> Date Issued <br />..�....��1-------------------______ , ���........ This Permit Expires 1 Year From bare issued <br /> 6: ...�. <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 /> e J} <br /> JOB ADDRESS/LOCA ON ..� 5 -.. :CJU4. <br /> _ CENSUS TRACT <br /> Owner's Name . . ......... .... ...�.... ..... ...... .. ........... < --.Phone _ `. T"d. ... .. <br /> ... <br /> Address ......_..._�-� . . A4 1 <br /> ------------------ City ........•••......:....................... <br /> Contractor's Name .._..._..0.... ... ................. ..... .:... � ................License # 2-.Y�.7.93_ Phone <br /> Installation will serve. Residen-ce-k-Apartment House0 Commercial []Tralier Court E] - <br /> Motel []Other ......n................... <br /> Number of living units:___...... Number of beds <br /> room .'.Garbage Grinder 8__� <br /> . .. Lot Size Q:".X:.I.Z _ .. <br /> .......... . <br /> Water Supply: Public System and name ______________ .. .- Private <br /> Character of soil to a depth of 3 feet: .­66n'd [] "ftat❑ Sandy Loam 0 Clay loam 0 <br /> Hardpan j] Adobe Fill Material ............ If yes,type .......................... <br /> .. <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 permitted if public sewer is available within 240 feet,} <br /> PACKAGE TREATMENT [ ] SEPTIC TANK f j Size............................................... .Liquid Depth ._.._..................... 1� <br /> Capacity --- --------- ..... Type .................... Material............. . No. Compartments <br /> Distance to nearest: Well <br /> -----•..............................Foundation ...................... Prop. line ._.... ............... <br /> earh�line:�-:.°..._......_ <br /> LEACHING LINE [ ] Na. of Lines -------------------- ... Length of ..•........ Total Length ----------•. ............... <br /> 'D' Box .._._....... Type Filter Material ....................Depth Filter Material .._._..._............. .................... <br /> Distance to nearest: Well ................... Foundation ..................... Property Line <br /> SEEPAGE PIT [ ) Depth .................... .Diameter -____= ....... Number ..._.... _____ Roek.'Filled Yes (] No (] <br /> Water Table Depth ------Rock-Size.............. ............. <br /> Distance to nearest: Well ` ..................... <br /> = =' Foundation Prop. line . <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ......................=- ----- `--•--••-- Date -•-•------------------------------) <br /> Septic Tank {Specify Requirements 'q -- , .... ................. - <br /> 1 .............. = = <br /> Disposal Field (Specify Requirements) .._..:.._ .......---.� ..�.K_.v 5.. .. - r__P <br /> ............................................._...---.-----•----•-•-----------•-•---••-----;-•-•--------.....•---•----•--••--------------------•----.............----•-----.............--••••-•--. <br /> IDrow-existing-ond required addition on reverse.side..)___; <br /> I hereby certify that I have prepared this application and that the work will be clone 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 /> "1 certify that in the performance of the work for which this permit is issued, t shall not employ any person in such manner <br /> ,as to become subject to Workman's Compensation lawn of'California." �` W <br /> Signed <br /> ...... ........ ........... -•--- -•----=- -- -------------------------------••---. Owner <br /> By .. t Title , <br /> ... ..........I.....----- ................................... <br /> (f of r han owner) <br /> PARTMENT USE ONLY / <br /> APPLICATION ACCEPTED i3Y ---•- ................ DATE ....6-= . ............:.... <br /> BUILDING PERMIT ISSUED ...... ... D TE ----------.. ................ <br /> ADRftIQNAL COMMEN S ..... . .t. ... !. <br /> ........... .............................. ..... <br /> •........................ . ..._..:.................._...___...._.......__..............------......... ............... .................. ..... <br /> Final Inspection y. -. <br /> ---�---- -------------•---•--...................------............-•---............Date .... ._.��-=?..�-�- ---- <br /> •JOAQUIN• LOCAL HEALTH DISTRICT <br /> } <br /> E. H.13 241-'68 Rev. 5M 7/72 3.M � <br />