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APPLICATION FOR SANITATION PERMIT ? <br /> Permit No. .. <br /> .... .. . ................... <br /> �.. (Complete In Triplicate) <br /> .. This Permit Expires 1 Year From Date Issued Dab Issued 5-d-77 <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 /> JOB ADDRESS/LOC ION .. , .7.... .. CENSUS TRACT .......................... <br /> ............... <br /> Owner's Name ... ..... ..........:.� G ............................Phone .. a��J ?. <br /> / ............ ........ <br /> Address .. . ..>�.........'ll�..l�. . .. -•---- ---- :. . ........... city ...... -------- <br /> 5"7 <br /> ... . ...... ..... <br /> Contractor's Name .... !.`� ............................................License # . �... .. Phone .."5-3k6 <br /> Installation will serve: Re dentepartment House 0 Commercial ❑Troller Court <br /> Motel ❑Other ----- --.... ........................... <br /> *lumber of living units_____________ Number of bedrooms . . Grinder ------------ Lot Size ---------___-------------------------------- <br /> Water Supply: Public System and name ............................a....-..................... ..........................................Private }- <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan j] Adobe ❑ Fill Mcterlal ............ 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,) �J <br /> PACKAGE TREATMENT ( ] SEPTIC TANK{ ] Size....... ........................................ Liquid Depth .......................... °0 <br /> �AXpeCapacity 4 aterlal...................... No. Compartments � <br /> Distance to nearest: Well ..../.. ........ ...................Foundation --1.v` ..1.-_..._. Prop. Line __� ... <br /> _..... <br /> LEACHING LINE O No. of Linesg g <br /> ..'.�.................... Length of each Ilne.-��--_.._............ Tota! Length ......... (� <br /> 'D' Box . <br /> �........ Type Filter Material Depth Filter Material ... .... <br /> Distance to nearest: Well ........................ Foundation ........................ Property Line ........................ <br /> SEEPAGE PIT ( g Depth Diameter ................ Number ............................ Rock Filled Yes ❑ No Q <br /> Water Table Depth ................................................Rock Size ................................ <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line ---------_......... <br /> -.- <br /> REPAIR/ADDITION(Prev. 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 accordant* 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 subject foorkman• Compensation laws of California." <br /> Signed ............ Owner <br /> By ...................................................................................---.......---...._. Tit;e ........................................................................ <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .. !-c _ - DATE ...�=..�1---7 ••... <br /> ...................................... <br /> BUILDINGPERMIT ISSUED ..................a...................................................................................DATE ........................................... <br /> ADDITIONAL COMMENTS ....... ......................................................•.--- . ............................................ <br /> ............................................ <br /> ........ ........................................... ••---.......................................................................................... .................................................. <br /> ..............................................................•-- --•--...................---.......----•-................................................................................................ <br /> ... .. .. .... ....... <br /> Final Inspection y: .... ..... .............................................................Date .. .f. ....-7................ <br /> EH 13 2h 1-613 Rev. -qt SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7b 3M <br />