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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> _ <br /> iComplete In TripllcPermitNo: <br /> dte) <br /> 6 This Permit Expires i Year From Date Issued � Date issued 1: <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 complia ce with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ../.Q.f.r ..... U <br /> Owner's Nome $ h �� ...................a ....... <br /> r CENSUS TRACT <br /> ..-j-.. Phone .. . <br /> Address ..._.._..----' f. �_. , . ......... City --.......... <br /> ti.. <br /> Contractor's Name ............. f�� ...... <br /> .----- ----�:-----... .............License #. Phone I��'6 <br /> Installation will serve: Residence Apartment Houseo Commercial []Trailer Court 0 <br /> I <br /> Motel El Other.............. ................................. <br /> Number of -livingunits:...... Number of bedrooms `s Garbage Grinder Lot Size <br /> l� <br /> ^ 'Water Supply= Public System-and.name .. ............................. �..................---............ -=�...�_�,,...................... <br /> s.. -• ...L. ....... <br /> .... ..................Private <br /> Character of soil to a depth of 3 feet: 'Sand t3 Silt❑ Clay 0 Peat C-1 Sandy Loam'16 Clay Loam <br /> ar pan C7" Adobe'p'-Fill Material - <br /> If yes, type ............................ r <br /> (Plot pian, 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 200 feet,) :� c <br /> PACKAGE TREATMENT ( � SEPTIC TANK <br /> ._S' e. _�._.�.�:................. Liquid Depth ... --_ ..,........ .� <br /> Capacity .�d ---- TYPe Material..(.. ...z'�..= No. Compartments <br /> vty <br /> Distance to nearest.• Well f <br /> ...................•••Foundation ....�L}..........._ Prop. Line . .......-•---- <br /> LEACHING LINE No. of Lines Length of ach Ii ... <br /> - Total length ..... 1 ? <br /> D' Bax ...... pe Filter Material Depth Filter Material .:..r._.._....... <br /> Distance to nearest:11VelI­__:.................... FoundationProperty Line <br /> l G...rt-. �.............. 3 <br /> SEEPAGE PIT Depth ... Diameter . Number ............................ Rock Filled Yes .d No 0 <br /> N ; <br /> Water Table Depth ...............................Rock Size 7 <br /> Distance to nearest.Well ........................................Foundation .......... <br /> .......... <br /> Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit,# .................. ...................... Date <br /> .. <br /> Septic Tank (Specify Requirements) ............................................................. <br /> ..... ....�.............. .. ........_................. <br /> Disposal Field (Specify Requirements) <br /> -------------------• _....... _-----------•------•...... ................ <br /> ............. ......:.. -...---•- -- -- ... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that.J.,.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: r <br /> ".) 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 /> -.._._ . <br /> BY ;title <br /> ..---------•----- <br /> (I ate tan owners <br /> _ FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED liY _. ........ _ 1 <br /> :.... ........... ....................... DATE _..... ."........ ................. I <br /> BUILDING PERMIT ISSUED ..- .._ ---: : ----------..DATE ....---................................. <br /> . <br /> A i]fTJONAL COMMENTS .... ... __.. . <br /> ............... ..................•........._......:............._................_..........................................__............................................ I <br /> ... ............ <br /> --.. .......::...... <br /> Q <br /> : ............ -----..... _ __ <br /> Final Inspection by: ... 1­1 Date -77� ... .... <br /> J�� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ;-j,L13 241._-jan__ _ i <br />