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r <br /> FOR OFFICE USE: ! <br /> APPLICATION FOR SANITATION PE,,,AIT <br /> (Complete in Triplicate) Permit No. ....... . . . <br /> ............... ....•-.......--------------...-........ <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 application is made in compliance "th County Ordinanc No. 549 and existing Rules and Regulations. <br /> r <br /> JOB ADDRESS/LOCAT N .-.�.7�7..�b.......................��..:......- ... C> NSUS TRACT <br /> Owner's Name ..... • ...... .....ta...........................................................,Phone_.............. ................... <br /> Address ...LQ. `.. .. 5---:-----•--.-------- ---- City -.- �� <br /> . . ... <br /> o ............................ <br /> Contractor's Name - ,...�.�----J:`:--7-:' .. kicense # --. Phone .............................. <br /> Installation will serve: Residence Q'Apartment House❑ Commercial :❑Trailer Court ❑ <br /> Motel ❑Other -------------------------- ---------------- t � <br /> Number of living units:.......... Number of bedrooms ........Garbage Grinder ,i?A--. Lot Slze ./� —X.... 3-..?.1.0 <br /> Water Supply: Public System and name .................................... ----------------------------------------------------------------------Private (� <br /> Character of soil to a depth of 3 feet: Sand❑ Silt o Clay ❑ Peat❑ Sandy Loam 0 Clay Loam {?�-- <br /> Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type ............................ <br /> {Plot plan, showing size of lot, location of system in relation #o- 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 /> PACKAGE TREATMENT [ ] SEPTIC TANK I I Size..- .ry ._ _.?C- ................_. Liquid Depth -5..-- ...--_ <br /> Capacity .. 600 .. 'd Type f-c. Material------0-1 No. Compartments -�............... <br /> ... I , <br /> r �• <br /> Distance to nearest: Well .r$G._.'f`....................Foundation ._/.�-..' ..-._---. Prop. Line .40-------------- <br /> LEACHING LINE [ ] No. of Lines .__-- i y � ^ + <br /> .......-- Length of each line...74?_..:-... d- Total Length ..-.`5-.--•--_•-------__--- <br /> 'D' Box Type Filter Material 57f.!!?:......Depth Filter Material /3 .. ............................ <br /> Distance to nearest: Well ....... Foundation .......... Property Line_ .t-:57.--f.......... <br /> SEEPAGE PIT [ ] Depth .. .............. Diameter Number ...... ................ Rock Filled Yes '91-� o i❑ <br /> WaterTable Depth _........--•....................................Rock Size .. ..................-------- <br /> IDistance to nearest: Welt ........................................Foundation .............•...... Prop. Line ....................-. <br /> REPAIR/ADDITION(Prev, Sanitation Permit# _•_•................•-...................... Date ---------------------------------- <br /> Septic <br /> ----------.-••-•------ -----Septic Tank (Specify Requirements) ------------------------------------------ .....'"".. <br /> Disposal field (Specify Requirements) --- ...... <br /> ..............................................I. ...-----...----............---------.......----------•---......----------..--....------------. .......... ............. <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 Laws, and Rules and Regulations of the.San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature c6rtifies the following: <br /> j "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 r an's C nsation aws of California." <br /> Signed........-- <br /> .......I.................. Owner <br /> BY _-.... ...................................... <br /> Title ................. <br /> ilf other than owner) <br />{ FOR DEPART ENT USE ONLY <br /> APPLICATION ACCEPTED BY . DATE ._ -__`_�04 '•:r-• •-------. --- <br /> f BUILDING PERMIT ISSUED ....-...... --•---•............. .. ...................................................DATE ...................... .................... <br /> ADDITIONALCOMMENTS .......... .................-•......................................................................•--•---.- .........--- - <br /> ............................_..............._.... ...... . �' ..------........--.-....-.-...-.-............. ....-.............-. .....---.......-...........:..- <br /> ............ ... ... <br /> . .................................. Date . ..` <br /> .. ... . . .. . <br /> Final Inspection b <br /> P Y <br /> SAN JOAO IN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br /> F <br />