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I rO. .. <br /> R OFFICE. .USE. . ........_..- Permit <br /> : APPLICATION FOR SANITATION PERMIT ` <br /> k No. .,7 <br /> �........ .. . .. ........ .. . .. <br /> ..... <br /> (Complete in.Triplicate) .............. <br /> .................. <br /> This Permit Expires 1 Year From Date Issued Date Issued S........:....... <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 /> . ........CENSUS TRACT ......._....._...._._..... <br /> F JOB ADDRESS/LOCATION ,,.,,.c:�nnq�.o�...�_,�L._.�. .. .r.�-----..........-----.............................. - <br /> Owner's Name �.:. :... . 1�! ?...........................................................:.------ ........Phone .$$�3S1�° .............. <br /> Address ... _....._ ..............I--....••--.....I.........-- Cit .......... <br /> ,I x.. .. v <br /> Contractor's Name .._.-_..._. ...................-•-•...........License # ------------------------ Phone .............................. <br /> FInstallation will serve: ResidencegApartment House Commercial []Trailer Court F1 <br /> l Motel ❑Other ............................................ <br /> Number of living units:.-.-!....... Number of bedrooms ....•-•?.......Garbage Grinder........ Lot Size ............... <br /> A Water Supply: Public System and name ..............................................._------- ..................................Private, <br /> Character of soil to o depth of 3 feet: Sand E] Silt❑ Clay Peat[] Sandy Loam ❑ Clay Loom <br /> Hardpan❑ Adobe-C] Fill Material ............ If yes,type -_..._.---..---_-._..___.... <br /> F <br /> (Plot plan, showing size of lot, location of. system in relation to wells, buildings, etc, must be placed on reverse side.) <br /> FNEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK k ] Size................................................ Liquid Depth .......................... <br /> �a-�- T .. Material._ ZU.. No. Compartments ..0................. <br /> _ <br /> Capacity ..- . - Yp OD a- <br /> �� � }} 00 <br /> Distance to nearest. Well ...�-----•..........................Faundati�n ..�[1�............ Prop. line ...ls.�. ...__._.... <br /> I tj <br /> LEACHING LINE [ ] No, of Lines ...�............... length of each line......��._............. Total Length ..... <br /> ,,._p, ' t� <br /> 'D' Box ..-` -_.. Type Filter Material -_.. -..._` j.__D pth Filter Material ...... ................................. <br /> .. <br /> I j i i <br /> Distance to nearest: Well .� Property� �_��.:�'....:..... Foundation d--...--••------. Pra a line ._.�.............. <br /> I SEEPAGE PIT [ ) Depth -------------------- Diameter ................ Number ............................ Rock Filled Yes [3 No Q <br /> F' � Water Table Depth ........................:Rack Size <br /> Distance to nearest: Well�-•........... ........................Foundation •--•--.............. Prop. <br /> Line ........... � <br /> REPAIR/ADDITION(Prev. Sanitation Permit# <br /> ............................................ Date .................................. <br /> Septic Tank (Specify Requirements[ <br /> iDisposal Field (Specify Requirements) ...................................................................................................................................... <br /> .....-._.........................._....---------....._.........__............_.._......---._...._.._. .._.-..-•-----------••---.......-....-..-------------------.-------------------•------------• - <br /> ...........................................................................................................•----------....---...............------------•---•----...............-----------•----......... <br /> (Draw existing and required addition on reverse side) <br /> Fjk' <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 sub' ct Wor n's Co nsation laws of California. <br /> Signed ' ' ... Owner <br /> BY -'.................................................................---------------------------.......... Title ............---....................................--------............. <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> a APPLICATION ACCEPTED BY .... -------------------------------•-•- --•---....._..-----------............ DATE ... ...:.:5 ---• ............. <br /> BUILDING PERMIT ISSUED .... ...................................................:..............DATIr <br /> ........................................... <br /> ADDITIONAL COMMENTS .....................•-•-----....................................._.................. .............---............................:................... <br /> ........ <br /> ..................................................... .•.........•--•-••---•..................----------•-...........------..._........................_........-----------•---...........------............ <br /> .... . -----•-- ............... <br /> Final Inspection by: ... . .. .............. - Date ...... .-. -........._... <br /> F` SAN JOAQUIN LOCAL HEALTH DISTRICT r� <br /> l _ . _ Cn <br />