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FOR OFFICE USE: �"30 Lee /7� <br /> ( APPLICATION FOR SANITATION PERMIT <br /> t Permit NO; .-..�<.�. <br /> ---- <br /> ..................... <br /> ---.... (complete in Triplicate) <br /> . . ....._.....-_.-,.. ------------------*- Date Issued .X7Z .77• <br /> k ... This Permit Expires 1 Year From 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 and existing Rules and Regulations: <br /> / Q ....-CENSUS TRACT ................. <br /> JOB ADDRESS/LO TIO f� .-�_.'.-. :. �••.' <br /> Owner's Name�!/Ar• ...............:- ..... <br /> .... .......... ..... .Pilon <br /> 1�.2._-.1.lJ v... .._.. - city "�. ------....................... <br /> Address -. --.- ... <br /> --._.:--......License# - --' ._ Phone ...-.-....--' .... <br /> Contractor's Name_............................. ..---- --..P.......-.....-.....--- <br /> installation will serve: Residence . Apartment Housefl CommerclakoTraller Court <br /> Motel ❑Other.............. .............-------- <br /> Number <br /> ......Number of living units Number of bedrooms ............Garbage Grinder ............ Lot Size . � .--_...-... <br /> ' '..-. <br /> Water Supply; Public System and name ..............................-........................------------..-... <br /> ----.................Private x <br /> Character of soil to a depth of 3 feet: SandEl SiltO Clay ❑ PeotV Sandy Loam❑ Clay Loam❑ <br /> Hardpan❑ Adobe❑ Fil I Materiai --- ---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,) <br /> (`r PACKAGE TREATMENT [ I SEPTIC TANK 1 , Sizofl(_r.XlQ:_,X� .. Liquid Depth .-------------------• � <br /> capacity/0-5---..- . Material C!L✓e.'..... No. Compartments _f'^_._....._. 'Sl <br /> ,Type,:•...........:.::.. � <br /> .,_..... <br /> Distance to nearest: Wei�P,P!�0 __. GY�.---....-Foundation ._...�..-_..._-.-. Prop. Line .- V <br /> LEACHING LINE [ } No. of Lines .-_.: <br /> . . --- Length of each line_.....-��............ Total Length ............ <br /> •D' Box .__.._:_.._ Type Iter Material ....................Depth Filter Material _.-------- --••----••-••••••-•• 1= <br /> Distance to nearest: Well ............... Foundation ....---------------._.-- Property Line, -----..._.--.-_-.-_.---. <br /> SEEPAGE PIT ( ] Depth ____________________ Diameter ___._.-__-_.._ Number ----........---............. Rock Filled yes ❑ •No Q <br /> Water Table Depth .._............................................Rock Size ------------------------------ i <br /> Distance to nearest: Well ------ ---_---_--__-_.._ ... <br /> .--___.._Foundation ................. Prop. Lin <br /> -- e ................... f { <br /> • REPAIR/ADDITION(Prev. Sanitation Permit# .............. .... Date ..................................) (� <br /> Septic Tank (Specify Requirements) --.. ............ ............... -------------".....-____...................... <br /> • <br /> Disposal Field (Specify Requirements ................................................................. ............-,.-__-__......................__.-............. <br /> ,._ <br /> ---'-'--'---"....-'--"------'--..-..----'--'-'-'-'--'_'-'.:..:..............,._........._----............._-.................-...................------------------' <br /> .......... ------"--'---. .-P... ...{D... - <br /> -......- -------'----..-------------------'---•--------------'-•---'---.............._-..----------.._...._..__.-... <br /> « W existing and required addition on reverse side) <br /> I hereby certify that I have re..ared tills 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 /> "1 certify that in the performance of the'Iwork for which this permit is issued, i shall not employ any person in such manner <br /> as to become subieet to Workman's eompensarcm laws of California." <br /> i Sig ma:.............._.......-------------- Owner , <br /> .............. <br /> (If other than owner) , /77- <br /> 7 FOR DEPAttTMENT USE ONLY <br /> APPLICATION ACCEPTED BY__. -- ------ ------ -�--.-.�-/may-�-• -- / _ -.DATE..<-G.•���.. 7-7. <br /> BUILDING PERMIT ISSUED---------..__..•--------.......... Y ......__......... .... <br /> .-... ._._.......___.-GATE .....-...........----'--------------- <br /> ADDITIONAL COMMENTS -__---------------.:-..-'(3- -----.. ... . <br /> _._._.-.-._................._-- .... ;; rt�Ga - .....2 !_.ha=! "' ,--• '--_......_..------.^_.-.... .....'..._... -. <br /> '-- ' " ' ' ' . .... ..-...-� ........... <br /> Final Inspection b -. --- - --- -._...............---------...---------._..;..._..........-....-..Date. ..-.. -7- .. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ` E.H. 9 1 68 Rev. 5M <br />