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FOR OFFICE USE: *Z <br /> �" APPLICATION FOR SANITATION PERMIT <br /> ---------------------------------- ----- --------------- <br /> (Complete in Triplicate) Permit No. -2a, <br /> ---------------------------------------------------------- <br /> ---------------------- This Permit Expires 1 Year From Date Issued Date Issued _". <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 /> f"-- CENSUS TRACT <br /> JOB ADDRESS/LOCATION .------------------- �7---'��"`-- ---------=-------- <br /> Owner's Name ----'l-f- : < ���`'� �✓ -------•----------------------------------------------------- -------------------Phone ------------------------------------ <br /> Address ------------------------------------� 761 tw ------------- -- -------•----- <br /> CitY <br /> Contractor's Name oo— -------------------------------------------------------------------License # ---------:-------------- Phone ---------------------_------- <br /> Installation will serve: Residence ®Apartment House-[:] Commercial❑Trailer Court i❑ <br /> Motel ❑ Other -------------------------------------------- <br /> Number of living units------.t' Number of bedrooms ----a_---__Garbage Grinder ------------ Lot Size -------------------------------_._._-_-_._- <br /> Water Supply: Public System and name ---------------------- -------- --------------------- --------------------------------------------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay .❑ Peat❑ Sandy Loam ❑ 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'[ l Size------------------------------------------------ Liquid Depth -__------_----_-..-_-__ <br /> -------- . <br /> Capacity ------------ Type -------------------- Material---------------------- No. Compartments .._.-_....--- = <br /> �-- .. \ <br /> r 0 <br /> Distance to nearest: Well --_--------------------------------Foundation ----_-__-_--_--_-___ Prop. Line --- .................... <br /> LEACHING LINE [ J No. of Lines ------------------------ Length of each line---------------------.------ Total Length ,_--_-..__._-_._---_---_-_ <br /> 'D' Box ------------ Type Filter Material --------------------Depth Filter Material -----------------------------------.._------ ' <br /> Distance to nearest: Well ________________________ Foundation ------------------------ Property Line --------- -------------- <br /> SEEPAGE PIT [ J Depth -------------------- Diameter --------..-.-- Number -------------..------------- hock Filled Yes ❑ No i❑ <br /> WaterTable Depth ----------------------=----------------=--------Rock Size -------------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation --------------- ---- Prop. Line ------------ ......... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------I <br /> Septic Tank (Specify Requirements) ---------------------------------------------------------------------------------------------:--- <br /> Disposal Field (Specify Requirements) --ed '.. -_- _...e------- -"--- �f - ` _� :0- of jV - <br /> ------------ -:--- <br /> ---------------- ----------- --- ------------------------ ------------------------------------------------------------------------------------------------------------------------ -------------- <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 follawing:. <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 of California." <br /> . - 0 <br /> Signed J .s .�'' y� �_ ,_e.-,,._r,----- Owner <br /> BY ----------------------- ---------------------------------------------•---------- Title <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED' BY -.. .-+.r..� ------------------------ ---------------------------------------- DATE {' f ------------------- <br /> BUILDING PERMIT ISSUED ----------------------------------------------------------- ----------------------------------------------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS ----------------------------------------------------- - -------------------------------- ---------------------- ------------------•- ---------------- <br /> -------------------------------- ---------------- --------- ------------------------------------------------------------------------------------------------------------------- - - ------- <br /> - ----------- <br /> �Final Inspection b --------------------Date <br /> - -------------------------- --------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'66 Rev. 5M <br />