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FOR OFFICE USE: ,/ APPLICATION FOR SANITATION PERMIT <br /> f� Permit No. <br /> ......--••-- .... :. ... <br /> (Complete In Triplicate) � - <br /> ............................... .. <br /> Date Issued /.-3.1-_-• • .. <br /> ........... . <br /> This Permit Expires 1 Year from Date Issued <br /> ........... .......... <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 /> ,,rr 1f ...................•---...CENSUS TRACT ................. <br /> JOB ADDRESSAOCATION 3_2. -.5.._Q-...u_u.Y{. _.s-f..S�._./1.!/ :..... ...... <br /> n0 <br /> Owner's Name .r�.a.r►1. _. .......!- . ... C,•-•..........................._..Phone .. . ..�i��.l�.. .. .... <br /> Address .,3.� _ ...�'_u.Yt.�'t. _�:.5�- !/C = ----- .--....... ty �� T! KTo._y............... <br /> _ ...License # -------- ---.-- Phone --------- •................... <br /> Contractor's Name ------�----------��- ---•----------•-•------------------------••---------- <br /> installation will serve- Residence M Apartment House Commercial❑Trailer Court 0 <br /> Motel ❑Other _------------------------•----••--------•- <br /> Number of living units:-----L---- Number of bedrooms'__._ --.Garbage Grinder --lJ--°---- Lot Size ----- --'-•••r't G i <br /> -----• <br /> Water Supply: Public System and name ........... Private 8 <br /> Character of soil to o depth of 3 feet: Sand'❑ S11//t❑ Clay ❑ Peat❑ . Sandy Loam ❑ +Clay Loam ❑ <br /> Hardpan❑ Adobe❑ fill Material ............If yes,type ............... ............ <br /> (Plot plant, showing size of lot, location-of system in!relation tawells, 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 /> ... Liquid Depth ..-----_---_------ .- - <br /> PACKAGE TREATMENT—(.).,_SEPTIC TANK.[..I �___�_ Size......-•----------••---•-:---- -- --- � p <br /> .Capacity =z;F_ �Type <br /> --- --.. Material-------------_------ No. Compartments ...................... <br /> J ..Distance to.-nearest- Well --Foundation----------------------- Prop. tine .._...--•-----•----- <br /> [ ] No. of Lines -------------- ------ Length of each line----------..---••-•__....._- Total length ....._........_............. <br /> LEACHING LINE � <br /> --�-�- 'D' Box " `~Type Filfer Material -'' ......Dipfli fifer Material ....................................... <br /> y. —--._ ._— <br /> -_;_ " . . ___7_S foundation Property Line <br /> Distance to;nearest: Well'......:......:... --------_........_.... p rtY <br /> SEEPAGE PIT ( } Depth ---_?, . -....._..- Diameter !. ...... Number __.. . ................... Rock Filled Yes ❑ No �❑ � <br /> ... <br /> Water Table Depth ---------------­- Rock Size p <br /> Distance to nearest: Well ...:-•....:---••----------------­-----Foundation ------ ------------- Pro Line .......... ..:..._ <br /> R1 PAIR/ADDITION(Prev. San.itatiors3ermit# ...._. ................ Date ...•----------------- •----- } <br /> Septic Tank (Specify Requirements) ........ ..... ... . <br /> .- -. _... .......... ..... <br /> _ .r <br /> Disposal Field [Specify ;Requ�rerhents} ............... ----------------------_- <br /> ----- <br /> ----- •---- .._.... <br /> --- -•---------------- -------- <br /> -- <br /> (Draw existing and required addition on reverse side} <br /> I hereby certify that I have-prepared-this-application attd'that the work will be done In accordance with San Joaquin <br /> aod Regulations of the San Joaquin Local Health District. Home owner or lieen- <br /> County Ordinances, State Laws, and Rules' <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 j I t to Workm n's compensation laws of California." <br /> Signed -•--•-- <br /> TM --- Owner <br /> --: ._ .. _ - •------- ...-• -----....--•- <br /> kTi .......................................................... <br /> ------ -----_----i--- tie <br /> (If other than owner) I <br /> DEP RTMENT USE ONLY <br /> f APPLICATION ACCEPTED BY ---"\.: .. . .......... ... <br /> .... - ---. DATE ........ - J 7 <br /> BUILDING PERMIT ISSUED ------ DATE .. --._..-•- <br /> ---- <br /> ADDITIONAL COMMENTS :-/.. . -i — x; 29-- ,,,- a"�` <br /> Z_Z..... . ���--- --- -------- -- - --- <br /> c ,�.. ----------------------------- <br /> ------------------------------------------------------ ..... <br /> ------- --------- ------ - --------------------•---- ...................................... --...._._------------------ -------- -- ------ ....... <br /> Date ._. a`?1.. ... ............... <br /> Final Inspection by. -- ------ ----t..-•---..... ... <br /> EH 13 24 1-6th Rev. 5i SAN JOAQUIN LOCAL HEALTH DISTRICT 8 7h1 3M <br /> R <br />