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FOR-OFFICE USE: <br /> APPLICAfION"001t SANITATIO N."ARMIT <br /> Perm+NA_. <br /> ...............__._................ ........ <br /> (CoirFP16F <br /> ._....,.--------•••............................. Date Issued <br /> ........ .......... This Permit Expires 1 Your From Date Issued <br /> Application is hereby mode 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/LOCATION ......_!;?_2-­%I­-D.00-;-�/�-- CENSUS TRACT --------------_----- <br /> �w <br /> .._....-•-•• ----Phone.................................... <br /> Owner's Name ....... <br /> _--------------- <br /> zk <br /> c?S___Z Ci ....... ......... <br /> .................. ty .... ............................. ..................... <br /> Address ............. ..­_---------2..... .S..... <br /> Phone -_--_---------_--------- <br /> Contractor's Name --•-•--- :!!t;$7�........... ...... <br /> Installation will serve: Residence GrApartment House[:] Commercial C]Trailer Court '0 <br /> Motel [:]Other ...----•--•----------------•---------------- <br /> i .. ................. <br /> Number of living units...J...... Number of bedrooms ......._._..Garbage� Grinder ............ Lot Size .... . . <br /> Water Supply: Public System and name .................. ............................I..............................­­.................Privote.0 <br /> Character of soil to a depth of 3 feet: Sand TE jilt C] Clay C] Peat El Sandy Loom C1 Clay-Loom 0 <br /> AdobeD Fill Material ......--.,!f yes,type.......... <br /> -Hardpon F-1 <br /> (Plot plan, showing- size of lot, location of system in relation td' buildings,wells, buildi , etc. must be PIocon reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet) <br /> PACKAGE TREATMtNT SEPTIC TANK Size..___._----------------------------------------- Liquid Depth ------------------- <br /> --------- No. Compartments --- ....... <br /> Capacity .................... Type ................--- Material. <br /> Distance to nearest; Well ...................._.............Foundation ....... .... Prop. Line ----•-•------_....._._ <br /> .. <br /> LEACHING LINE No. of Lines _..----_------_------ Length of each line..................m......... Totd] Length <br /> 'D' 'Box...... ...... Type Filter Material -----_-------------Depth Filter Material ------_--- .............. <br /> �'Distance.to nearest. Well ........................ Foundation ........................ Property. Line ---------_------------ <br /> SEEPAGE PIT Depth DiaMeter . Number --------- ----- ....... Rock Filled; Yes <br /> 0 No <br /> Water Table Depth ....... <br /> Distance to nearest ... <br /> Well ............. ------...__Foundation ......... .......... Prop. 'Line .............. <br /> ......... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ......... .......................-.AL..... Date -----------.._-..___-------•-•--j <br /> ........................ <br /> equ ......... ---------- X <br /> Septic Tank (Specify Requirements) ------------------------------ ..................... ------- -----------------.. <br /> ..G{,.,_. ..................... <br /> Disposal Field (Specify Requirements) ------- <br /> ........................................ ....... <br /> ........................�Y.. ...................................--------- <br /> ------------------------------------------:.......;....................... ............................ --------------------------­................................................. <br /> I (brow existing and required addition on reverse side) with Son Joaquin <br /> I hereby certify that I have prepared this application and that the work will be done In accordance <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: , I shall not employ any person in such manner. <br /> "I certify that in the performance of the work for which this permit is issued <br /> as to become subject to Workman's Compensation laws of CCIif0Mia-" <br /> Signed ........ ........................_­............. .................................. Owner <br /> By ...................................................................................................... Title..... ---------------------------------------------- ------ <br /> (if other than owner) <br /> F9R DEPARTMENT USE ONLY <br /> /­----------- <br /> .. <br /> APPLICATION ACCEPTED BY...-_­_A'_1, .. ........... ............ ..................... DATE .... a <br /> ------------------ <br /> BUILDING PERMIT ISSLIED ......................... ....... ..............DATE ....................... - <br /> ------------------------------------- ............................ <br /> ADDITIONAL COMMENTS $PO----------- <br /> ....................... .........................._--------------------- ............................................................................ <br /> ..................................------­---­--­­­-------------------------------- ---•------------•----•---._.._.._......... ......................................... ....... <br /> -------------............. <br /> Final Inspection by: . ...- ................-•- . ... . .... <br /> Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev, 5M <br />