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FOR OFFICE USE: )j k I <br /> APPLICATION FOR SANITATION PERS ��" <br /> - - <br /> (Complete in Triplicate) Permit No. .-7_L--_ <br /> -- ----- ------- - Date Issued --Z--' - <br /> -.--.-.-7 y <br /> ----__,-_--_,_----.-._--_--_,- 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 �O`r�dinance No. 549 and existing Rules and¢Regulul1a_tions: <br /> JOB ADDRESS/LOCATION .__.....13.4- ------F��QSS`.-/�lxE�Cs�F�Q. .�Z ------------CENSUS TRACT .c7...+. ..-..__.. <br /> Owner's Name bS 3 <br /> --------- Q�yY�1lV. �YGI'�lQ l= - Phone -- Ot <br /> Address ----------�'?`rN �'l L ------ -----_--•--. City --------•-- ------------------------- ------_---- <br /> Contractor's Name -------- 1: - ------------- ------------ -----.License # ------ ----------.. Phone .................... ------ <br /> Installation will serve: Residence ❑Apartment House 0 Commercial ❑Trailer Court <br /> Motel ❑Other ------ .---- <br /> Number of living units:_--,5---. Number of bedrooms -. ._---Garbage Grinder _y6J__ Lot Size --------- ---------------------------------- <br /> Water Supply: Public System and name ----------------------------- -------------------------- -------------- ---_---------_--------- --------Private <br /> Character of soil to a depth of 3 feet: Sand❑ Sift❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe0, Fill 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,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK.t ] _ Size-------- <br /> P-&--- <br /> -------------------- <br /> _ ---- Liquid Depth -__-_ -.--- <br /> od Cw P��----- <br /> Capacity �a.- -- --- Type - -- - ------ -- -- Material--------- - --------5 0. Compartments -- ---•--y-•-:....-_ <br /> Distance to nearest: Well _..___a Q9.-.--._.__.___.-Foundation ...-.___._...___.___ Prop. Line .SV__--:_.------ <br /> LEACHING LINE [ ] No. of Lines _.-..3-----------_- Length of ea line�_�-_.�e9 -------- Total Length t...v'L __-._---------. ` <br /> 'D' Box � _ Type Filter Material __ - _'D'ep'tTi Filter Material __:L_0_----_-------------------.---- <br /> i <br /> Distance to nearest: Well _.__%�f�Q------ Foundation Property Line _.__ _-------- <br /> SEEPAGE PIT ( ] Depth ------------ Diameter ---_-----.----- Number -------------------------..- Rock Filled Yes ❑ No I❑ <br /> Water Table Depth .... .._ --------- _-------------------------Rock Size ------------------------------- <br /> Distance to nearest: Well ----------------------..................Foundation ------- -----------. Prop. Line .....-_--------.----- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------------------------------. ) <br /> Septic Tank (Specify Requirements) <br /> Disposal Field (Specify Requirements) ------------------------------------ -------- -------------------------------------------------------------------------_------- <br /> ---------------------------------- <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 Laws, 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 blect to Workm n's Cpmmpensation laws of California." <br /> Signed NQLic "'�`� --- Owner <br /> By ------------------------------------------------- -------- ----------------------------------------- Title ...- - <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -------- - ----- ---- - -- --------------------------------------------- DATE Z' --- ----- - -------------- <br /> BUILDING PERMIT ISSUED --------------- -------------------- --------------------------------------DATE <br /> ADDITIONALCOMMENTS -----------------------_------ ------------ -------- --------- --_.-------------------_-_------------------------- ------'------------------------- <br /> ^rAA <br /> ----------------------------------------------------------------------------------------------------------------------- <br /> ------------- -------- ------- ------- - ------------- -------------------- ------ ------------------------------------- ---------------------------------- <br /> ------------------------------------------ ------- ----------------------------------------------- <br /> Final Inspection by: -----------------------------------------------------------------.Date _-- a�'�7—_--- <br /> JOAQUIN LOCAL HEALTH DISTRICTa u o 'Ro D <br />