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k I <br /> t FOR OFFICE USE: ("pPLICATION FOR SANITATION PERF <br /> Permit No. <br /> %......... <br /> (Complete in Triplicate) <br /> ...... .. .. ............. ... <br /> ------------- This Permit Expires I Year From Date Issued Date Issued . . <br /> " t <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 ith County Ordinance No. 549 and existing Rules and Regulations: <br /> r-e��-r z- f �`.. . S TRACT <br /> JOB ADDRESS/LOC N --_.-_-,------- -- - - -- - r"'"�`` <br /> Owner's Name --- Phone ---- - -- -------------------------- - <br /> Address rl `.' y-- ------ --.?-Cv .��.----- City ------ - ---- ------------------••- <br /> ` '.License # --1 . <br /> Contractors Name �.�:,. f --..... - �~-' ---------- ---- - Phone <br /> Installation will serve: Residence Apartment House E] Commercial ❑Trailer Court ;❑ <br /> J Motel ❑ Other ... - -------------------------- <br /> Number of living units:....!...... Number of bedrooms ...Garbage Grinder ..... Lot Size ..__..«'a-- '' :. <br /> Water Supply: Public System and name .... ------ ----------------------------_.. ------- -------- _............................Private <br /> Character of soil to a depth of 3 feet: Sand❑�lt E] Clay ❑ Peat❑ Sandy Loam E] Clay Loam ❑ <br /> Hardpan Adobe ❑ 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---------------------------------------- ------- Liquid Depth --- ---------------------- <br /> Capacity ..................... Type ----- ' --- Material.------- ............. No. Compartments ....----- <br /> Distance to nearest: Well ------------------------------------Foundation ..---------- Prop. Line ------------.--------- <br /> LEACHING LINE { ] No. of Lines --- .... Length of each line......... Total Length ------ --------------------- <br /> 'D' Box ...... - Type Filter Material --------------------Depth Fitter Material -------------.------------------• -._--•--- <br /> Distance to nearest: Well . .-- ----- Foundation ------------------------ Property Line -....-------- <br /> SEEPAGE PIT [ ) Depth --------- --- - --- Diameter ---------------- Number .........................-.-- Rock Filled Yes,[] No ❑ <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 /> --- ------- <br /> Disposal Field (Specify Requirements) � j-;�-----�,- -- <br /> ..... .. ................. ... ......... -- -- -------- ---------- --------------------- ------ --- ------- --- - ------- -------- ----------- <br /> (Draw existing and required addition on reverse side) <br /> 1 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 Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that i e performance of the work for which this permit is issued, i shall not employ any person in such manner <br /> as to bec a su to Workm Compensation lows of California." <br /> Signed .. .. = ..... Owner �� <br /> .... . L -----... <br /> `' '... .. Title _._. - � <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY . . -- DATE . "- 6.-`G <br /> BUILDING PERMIT ISSUED .. ....... ... ...... . ... ..,......... ..----....--------.....-.-. -DATE ................ ..... ----------- <br /> ADDITIONAL COMMENTS ... ............. .. ......._..-.....-- - - ------------ ____............. ............------------- ...... --- ------........-- __ <br /> ............... .... . . .. ...... ...........---..........------..-.--...-.. .....------ . . . <br /> - - i <br /> ... ....... y fir/f <br /> i'!ral !nsnECTion oy. ... .. .. -- ---- .. ................ ............ . ...... .. .Date... "/- ~-". I--. '' '-fit------ <br /> SAJOAQUIN—LOCAL HEALTH'-DISTRICT <br />