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FOR OFFICE USE: <br /> s APPLICATION FOR SANITATION PERMIT <br /> ............. -- ----- 7g- ?77 <br /> {Complete in Triplicate) Permit Na :.................... <br /> ............................... <br /> This Permit Expires ] Year From Date Issued 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 opplicdtion is made in <br /> compliance <br /> }with Co my Ordinance No. 519 and existing .Rules and Regulations: <br /> JOB ADDRESS/LOCATION ........................... ..... .......-......!.............CENSUS TRACT .......................... <br /> Owner'sgme s..... Phone -.---..__ <br /> Address V ------- -------- City .V :. <br /> Contractor's Name --____-- -- - L€canes # . ��,� 7+ . Phone .440 7.! <br /> --- - --- - - <br /> r <br /> installation will serve: Residence B'Alp"artment House 0 Commercial ❑Trailer Court ❑ <br /> Motel ❑Other---------------------_.................... _ <br /> Number of living units:_._/----- Number of bedrooms ....Garbage Grinder ............ Lot Size ....r�. ...........................::........ <br /> Water Supply: Public System.ond name .......................:....................................................................Private' <br /> Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> HardpanX Adobe ❑ FIII 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: (No septic tank or seepage pit permitted If public sewer Is available within 200 feet,( �J <br /> PACKAGE TREATMENT [ I SEPTIC TANK,[ - €Ze ___ - - .�---..-_--- -Liquid Depth .....7................... <br /> _ . .. <br /> Capacity`26 .----- Type .............,Material.. No. ;Compartments '�Q <br /> ........... <br /> ff t ,. 77 <br /> Distance to nearest: Well __IQ.d.......................Foundation -,-/a.............. Prop. Line . r,/ r�...•......... <br /> LEACHING LINE [tj' No. of Lines .- ----------------- Length of tach llne.Yo..---V .../0.6 Total' Length .__..12.0... <br /> ._....... <br /> v <br /> 'D' Box ............ Type Filter Material S/ _ L.Depth Filter Material ....Z00. .......... ........... <br /> ' .. Foundation r........... Property.Line <br /> Distance to nearest: Well ,l�Q.-----_-�� _..1� ............... <br /> �,/ a <br /> SEEPAGE PIT (4 Depth --- ........ Diameter ��---.---. Number .........�--...--,_...._.. Rock Filled Yes �' No ❑ i <br /> r ►r s <br /> Water Table Depth ......11.6.................................Rock Size •- -._ ..�._._.._..-•------- � <br /> Distance to nearest: Well ....... .� 1_f..................f=oundation .... ........ Prop. Line .?3 .'......... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ................................ <br /> ..) <br /> Septic Tank (Specify Requirements) .................._.._ <br /> i <br /> Disposal Field (Specify Requirements) ................................................................... <br /> ...... <br /> ........................ .................................................... I <br /> (Draw existing and required addition on reverse side[ <br /> I hereby certify that 1 have prepared this application and that the work will be done In accordance with Sari; Joaquin <br /> County Ordinances, State Laws, and !lutes and Regulations of the San Joaquin Local Health,District. Home owner or licen- t <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 bec subiect to—Wark1 man Compensation laws of California." <br /> Signed - ----- - . .. ` AL- -----....- Owner <br /> BY - _ TrtI <br /> e ..--r ..l . ------_-._....--• ------ --------- --------------- <br /> (if other than ower) <br /> c.y FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTS 6 DATE .-- -= - .-p ..--------- <br /> BUILDING PERMIT ISSUED ---------------------------------------- •- ------------------------------.-DATE ........--_-.--------._...__._...-....... <br /> . <br /> ADDITIONALCOMMENTS --------------- . •---•-•-----•..........-------•--•--•----•---••----•--------- --•--------- ----------------------------------- ---=-----•--..•.......--------- <br /> ------------ <br /> a-_._..... .-_ --- ------------��--�'-�� ---- "---._..^_. ... ........_._.....-_....._. <br /> 9-------------------------­-L-...................L-------- <br /> Fina) Inspection by.- --------•- - .... Dat <br /> EH 13 2h 1-68 Rev. 5HSAN JOAQUIN LOCAL ALTH DISTRICTM <br /> � 3 <br />