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F,OR OFFICE USE: \§ <br /> • �` APPLICATION_ FOR SANITATION PERMIT <br /> - --------------------------- - S r �� <br /> :.. _Q\ . � \ Permit No. <br /> {Complete to Tr'splicatel { <br /> ------------- --- ---------------------------------- <br /> t Date Issued ...f <br /> _________________________________________________________ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein <br /> pp Y 9 <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ------- ---- V---_-----f G � ,�` ---- .--'.--------CENSUS TRACT -------------- ----------- <br /> Owner's Name --- --- - -- -------w --Phone <br /> - � <br /> r ---- �- city -- - ----------- ----•--- <br /> Address <br /> Contractor's Name -----/Z V_. '----- ��--- License# /-- - Phone _0,/�2 > <br /> Installation will serve: ResidenceX Apartment House❑ Commercial :[]Trailer Court '❑ <br /> Motel ❑ Other -- ° <br /> Number of living units:--/------ Number of bedrooms .-/--.....Garbage Grinder (-. Lot Size ._�.__ . -"-:-..-_-_---. <br /> 7 �.. <br /> Water Supply �Systeand name --------------------------------- Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑l' Clay Loam:O <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 /> k NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT f ] SEPTIC TANK [ ] Size---------- ------------------------• ----------- Liquid Depth ---------------- .._--..__ <br /> Capacity -------------------- Type --------------------- Material---------------------- .No. Compartments ---------------.------ <br />' Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------- -------- <br /> 0 <br /> LEACHING LINE [ ] No. of Lines ------------------------- Length of each line---------------------------- Total Length ------------ -------------- <br /> 'D' Box ------------ Type Filter Material ....................Depth Filter Material -----------------------------.--------.__:_..Z <br /> ,;. :� <br /> Distance to nearest: Well ---------- ------- Foundation ------------------------ Property Line ------------.......:.... n <br /> ,,!�SEEPA PIT [ ] Depth -------------- ----- Diameter k -----..t Number ---------------------------- Rock Filled Yes ❑ No '0 {l ' <br /> 1 Water Table Depth ---_.----._- �. 0 <br /> - ------- ------------Rock Size ------------ <br /> Distance to nearest: Well ---------------''._.-- ---.._--_.._._..Foundation _-.--_---------._- Prop. Line ---------------------- <br /> x <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------- ---------- Date -------------------_-------------_) <br /> Septic Tank (Specify Requirements) -- --------------------- ------ ------------------------------------------------------- •----------------------------- <br /> Disposal Field (Specify Requirements) ----------- � Q -Kr ' ------------- <br /> ----------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------_------------------------ <br /> ----- ------ ---------------I------------------------------------------------------------------ --- - ------------------------------------------------------------------------------------------ <br /> (Draw existing and required addition on reverse side) <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 subject to Workman's Compensation laws California." <br /> Signed ------------------------------------------------- ------ -- - ---------- ------------- Owner <br /> BY ------------------------------------------------- -- - ------------'''`Title; <br /> -- - -- ------------------------ <br /> (if other than own r] <br /> / -,-FOR DEPARTMENT USE ONLY . <br /> APPLICATION ACCEPTED BY ----- __ -==-----------s�ti .:g� ----= �� -------DATE 'Iz-,-7- ----------- <br /> BUILDING PERMIT ISSUED ---------------- - - ----- ,' t 4 .. ="" = ` -----DATE -------------.-- ---- <br /> -----------_ <br /> ADDITIONALCOMMENTS -------------------------------------------------'== ''-------..:------ ''-------------------------------------------- <br /> . R• <br /> _,.-.,.. <br /> .................................................................. ---------------------._----------------4_-._--------_.-._....-_...._........__-._..-------._....------_------.-__--.._ <br /> ........................................................................................................".-'.--------.................._.-...--------------------------...._.---------------------_-..._._ <br /> ................................. .� .. ...... _ .--.- - +�.r---F ------------------ <br /> FinalInspection by:�------------------------ ------------------------ ------------------------------------------------------Date -------------------------------------- ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M. <br />