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FOR OFFICE USE: <br /> "PPLICATION FOR SANITATION PF- '''T <br /> (Complete in Triplicate) Permit No. . <br /> __. .._-------__ ---------- ---------------------- This Permit Expires 1 Year From Date Issued <br /> 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 compliaze with County Ordinance No. 549 and existing Rules and Regulations: <br /> 0 / <br /> JOB ADDRESS/LOCATION l -------------/— ---------------------- ---- --------.-CENSUS TRACT ----------------- <br /> Owner's Name _. . . L'�i A' Cb.5Tlq-------------------------------------------------------------------------------------Phone ---------`-------. ------------- <br /> Address - f--- ----------------- Un2val_5-------------------------------------------------.------ <br /> Contractor's Name ---- ----TR_1 qC- cai1U&n- - ---- ---------------------..License # /3-36211- ----- Phone <br /> Installation will serve: Residence ❑ Apartment House❑ Commercial XTrailer Court ,❑ <br /> Motel ❑ Other -------------------------------------------- nn <br /> Number of living units:__..'-._. Number of bedrooms ...__.......Garbage Grinder --------- Lot Size ------------ ------ -------- <br /> Water Supply: Public System and name ---------- ------------------------- ---------------------------------------------------------Private [7� <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe X 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 Size.-------1060..91------------------. Liquid Depth ..�­.--__.-_--..----_. <br /> Capacity _Cdoo—_..__ Type _YreljN __.. Material� nQV4-t----- No. Compartments ..._�_....... <br /> ._. <br /> Distance to nearest: Well _ _af-_I----------------------Foundation -----fa_._.___-- Prop. Line ---!o U...-._____ <br /> LEACHING LINE [ ] No. of Lines ---- _ Length of each line------/0Q_ ------------ Total Length ---o?P_--.----._....- <br /> 'D' Box Ve_5___- Type Filter Material ►P_ ------ Filter Material ----- ��� Li <br /> Distance to nearest: Well _DOP- ........ Foundation _.__-/©.`.-____. . Property Line ___ --_.-...._.. N <br /> SEEPAGE PIT [ ] Depth _ _ _ --------- Diameter _.-__.______ Number ___---- ___-..-_ Rock Filled Yes E] No ❑\ <br /> Water Table Depth ----- ---------------------------- -------------Rock Size --------- - ------------------ <br /> Distance to nearest: Well -------....-_-----._.___.------ --_Foundation __ ------------- Prop. Line ._-_.--_.-..____.__ <br /> REPAIR/ADDITION(Prey. Sanitation Permit# -------- ___ ___-------------_---------___ Date ---...----------------------------) <br /> Septic Tank (Specify Requirements) _ __ _-_ --•-------------------- - <br /> Disposal Field (Specify Requirements) -- -------------------------------------------------------- --------------- - - - - -------------------- -- --- --- <br /> - - --- - ----- - --- - - ----- - -- -- -- --- --- - - ------- --------------------------------------------------------------- ---------- <br /> ------ ------ -------------------------- - <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 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 su6iect to Work ,�oenh laws of California." <br /> Signed --- � Owner <br /> TH <br /> BY .. ... ------------------------------------------------ - - -Title - <br /> - <br /> (If other than owner) <br /> FOR DEPARTMENT LS ON Y <br /> APPLICATION ACCEPTED BY ------------------------------------ ------- DATE -- 9" ��------.------.------ <br /> - <br /> BUILDING PERMIT ISSUED0DATE <br /> - <br /> ADDITIONALCOMMENTS -------•------------------------------- ---------------------------------- -------------------------------•------=--------------------------- <br /> ------------ <br /> -----------------•-------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------•-•-•--------------------•--.-...---------•-•------------•-•--•--------•---------------. <br /> --- ------- ----------------------------------------------•-----•--• ................................................... -- - - --- <br /> Final Ins ection b Date ..o�� <br /> P Y ------ ------ ---- -- -------- - - <br /> SAN JOAQUIN LOCAL HEALTH TRICT <br /> E. H. 9 1-'68 Rev. 5M U01 <br />