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FOR OFFICE USE: , <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) <br /> Permit No. .7 "S8� <br /> ........................... This Permit Expires 1 Year From Dote 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 <br /> in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ..1"1 1 .-._41..:...jkX11. .........C7 ........::..........:.:.:::i..............CENSUS TRAL? ......................... <br /> Owner's Name .--A1A-E.-------^0 -eA .........................................................._........._.. <br /> Address .,».. i�ll�........ .. ............................................................_City ............................ <br /> Contractor's NameIr.....7VWk... rjC p........License # 1�,il.9V.... Phone <br /> Installation will serve, Residence X Apartment House C] Commercial(]Trailer Court 0 <br /> Motel []Other............................................ ` <br /> Nwnbe of living units,... ...._.. Number of bedrooms .—I....Garbage Grinder .../%'Q.. Lot Size .../..= sl...................... <br /> Water Supply: Public System and name ........................................................._..................................................Private <br /> Character of soil to a depth of 3 feet: Sand D Silt❑ Clay [] Peat 0 Sandy Loom ❑ Clay Loam Q <br /> Hardpan[] Adobe C] Fill Material ............ If yes,type ............................ <br /> (Plot pian, showing size of tot, location of system in relation to wells, buildings, etc must be placed on reverse side.) <br /> NEW INSTALLATION:' (No septii:,Ydnk or seepage pit-permitted If public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT <br /> [ l SEPTIC TANK�(J• — Size....�_•.1(.•S-�!.�3Y-.-:..........._ Liquid Depth ..-0..................... � <br /> Capacitya..apvp......:_ Type/0 TMaterialc`_'21./Yef4W..4No. Compartments ..�?...... . <br /> Distance to nearest: Well .___47r..`......................Foundation .../D.*........... Prop. Line:._:i71_f...... <br /> LEACHING LINE (� No. of Lines ......�............. length ofeach <br /> _'lJline.......�................ Total Length .ar�. .�l.L7........... <br /> . <br /> tS <br /> 'D' Box .-Y/c . Type Filter Material ,/.`••77AQfZ__Depth Filter Material .....I.g.'.............................. Z <br /> / ........ Foundation .... .. _ <br /> fJ <br /> Distance to nearesh Well ...�V.:.. f ............. Property Line .-I......._............ . <br /> SEEPAGE PIT ( I Depth ..... ............. Diameter Number .................._........ Rock Filled Yes ❑ No Q C <br /> Water Table.Depth ................................................Rock Size ..............._..._......... <br /> Distance to nearest: Well .......................................Foundation .................... Prop. Una ...................... P <br /> REPAIR/ADDITION lPrev. Sanitation Permit# ..............._........................... Date ............... .......1 <br /> SepticTank (Specify Requirements) .....................................................:..............................................................._................ <br /> DisposalField (Specify Requirctnentsi ............................................................................................................................... <br /> ............................................... •-----------------------------------.................---.......................................---------•--_..........._.._....._.._........ ..._.... <br /> ......................................................:............................................_.......------•-•----•-----•------------._....._......----•-------..................._....... <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certify that 1 have prepared this application and that the work will be done in accordance with Son 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 work for which this permit is issued, i shall not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed _.................................... .---- '-..._..... <br /> Title ........... T .......... <br /> (If other t- owner <br /> POW DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .... ...........................•-•............. ........... ......................._........... DATE <br /> BUILDINGPERMIT ISSUED ........................................................................................................DATE ..................................I........ <br /> ADDITIONALCOMMENTS ----•............................_...........--..._.............................................---------------..........................._.._.............. <br /> .............................................................................................................----•-..........-_....---....._...._...__._................................................ <br /> ...................:.............. <br /> ...._............... <br /> . .... .... --•---•---........................ <br /> _..............._............ .. .............. -.. . ...................................................... ..............._....-............:y........ <br /> Final Inspection by: _.. .. .. DaM ..'.:7::m •.. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H.13 24 1.-68 Rev. 5M 7/72 3 M <br />