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FOR OFFICE USE: APPLICATION --FOR 5ANITATION PERMIT <br /> : ._7_ <br /> ---- --- ------------------• -------------- <br /> y Per No1-3-4--g- <br /> (Complete in Triplicate) <br /> " Date Issued .-`/"_----------- <br /> This <br /> _. -.This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin L co )"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 /> �c1�3=s�-,✓-� - � _,~�-� g-� 04'.0•-�7 <br /> _ /� <br /> r W (.Bu-L '. v74_CENSUS_TRACT -D---- <br /> JOB ADDRESS/LOC ON - ' z �-- :"`�` 7f�.�""'��----- - -- <br /> . - _ <br /> Owner's Name .- - ---- -- ---- - --;��-----�'�``--------- -- --------�-�-.:,-------= --- --Phone - -�-�-- �---- -- -----� <br /> Address � �1� -- -------- - `Cifi -------------------- <br /> - Y <br /> F es+ + ense# -1'c'S l/ Phone - ..-�-- -- <br /> Contractor's Name _ `� <br /> Installation will serve: Residence"Apartment-House•,E-Comrbercial E]Trailer-Court-❑.- k <br /> t <br /> ' Motel ❑ Other -------------------------------------------- i <br /> t <br /> Number of living units:.--- -- "-- Number of bedrooms -:.!.F__---Garbage Grinder ------------ Lot Size ----.-_---."-------------------------------- <br /> Water Supply: Public System and name ---------- ----- ---------------------------------------------------------•-}--------Private ❑ <br /> s Peat Sand Loam Clay Loam <br /> Character of soil to a depth of 3 feet: iSand'❑ Silt Clay ❑ ❑ Y ❑ ❑ <br /> 1 F Ha'rdpan-❑ 'AdobeXIFill Material --__-.---"-_ If yes, type -.--------_---------------- <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: (Ndseptic tank or <br /> seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ I t ;SEPTIC TANK f ] 1 Q _,S¢i_ze----�?�--c7--------------------- ---- Liquid Depth --�_�_.-.--_---._..-- <br /> Capacity -IaC9 - -- Type 1Q.4- Material--�----- No Compartments ---�.............. <br /> rsr . --- <br /> Distance to:nearest: Well ___ --_---- --------------Foundation ------------- ------ Prop. Line ------------.----_--__ <br /> Z', # 8 - Total Length <br /> ----•-••-•-- <br /> LEACHING LINE [ j No.'--of Lines :.Length of each line 9 <br />�. D <br /> `Q''-Box :--� Type Filte Material _-".Depth Filter Material ---`- ----------------------------------- <br /> Distance to nearest: Well ------------------ ---- Foundation ------------------------ Property Line --------.--------------- <br /> SEEPAGE PIT [ ] Depth __sem-------_--- Diameter ------ Number -----1—----------- Rock Filled Yesv No i❑ <br /> i Water Table Depth -----------------------------i -----------Rock Size ----5= ------ <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ----- .............. <br /> REPAIR/ADDITION{Prev. Sanitation Permit# -------• ------------------ ---------------- Date ------------°--------..----------) <br /> Septic Tank (Specify Requirements) -------- ------------------------------------------------------------------------------------------------------------------------------------- <br /> I <br /> DisposalField (Specify Requirements) ------------------ ------------- -------------------------------------- ------------------------------------------------------------ <br /> --------------- 1 ------------------------------------------------------------------------------------------------ <br /> ----------------------- .- t <br /> t <br /> -------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------- - <br /> -------- <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,/ aws, 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 /> ( Signe - ----- ------- i OwnerGJ <br /> ----------- - <br /> Title --------------- ------------------------ <br /> {If other than owner) <br /> FO ART NT USE ONLY <br /> APPLICATION ACCEPTED BY - '- ------------------------------------------------------ DATE -' 'L �----------------- <br /> i r <br /> BUILDINGPERMIT ISSUED - -------�:--------------------------------------------------------------------------------- --- ----DATE ------- ------ ••--- <br /> ADDITIONALCOMMENTS --------------V`------------------- ----------------------------------- ------------------------------------------------- <br /> -------------------------------- --- ------------ ------- -- ---------------------------------------------- ------------------------------------------------------------------------ <br /> --------- -- -------- -- ---------------------------------------------------------------------------------------------------------------------------------- <br /> ---- ---- - " --------- ----:-_ <br /> - - -- - - --=- - ------= <br /> FinalInspection by: ---------------------------------------------- ---- ------------------•-------------------------------------- Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />