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FORIDFFICE USE: .70 <br /> APPLICATION POR SANITATION PERMIT <br /> ............ -------- 0 Zri <br /> ---------­---i...... - P-- ....... <br /> .#p.11 (Com'pl eia in Triplicate) <br /> -------------------­------ <br /> -1 1; <br /> ................................. This Permit Expires I Year From Date Issued <br /> 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 /> JOB ADDRESS/LOCATION ...... .............. CENSUS TRACT ....... ....... ......... <br /> .........................I....... ....... <br /> 4 q - 6,4 c,t� <br /> (2.4p 2 .........Phone ..t <br /> .1 ................. <br /> .5:........ ..................I——....... -6 .......... <br /> Owner's Name ...... . ........ <br /> City ... ........................................ .......... <br /> Addiess ........................... ------- .........­­........ <br /> Contractor's Nome ...... License #4 3.5A . Phone <br /> Installation will serve- Residence (JApartmentrHo'useO Commercial❑Tro.fler Court 0 <br /> I Motel F]Other <br /> Number of living units..---.-/,_- Number of bedrooms '.-2,..__Gorbage Grinder ... Lot Size ;�.................. .............. <br /> Water Supply: Public System and nam <br /> ie ..........:......•------ ----_---_---_------ ------------ .............................�­............Private El <br /> Character of soil to a depth of 3 feet.- Sand 0 Silt[D—Clay-o�_p a eatf)--San I dy—Ld'ami 0 Clay Loam-0�. <br /> Hardpan E] Adobe Fill Material ............ Iyes;4ype ------------------ <br /> (Plot plan, showing size of lot, location of. system in relation ta wells,- buildings, etc. must be placed on. reverse side.) <br /> NEW INSTALLATION: (No septic tank or.seepage pit permitted if public sewers available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK-T I I Size........ .............. Liquid Depth ....._1..._........I.._... <br /> Capacity ........L...... Type Material..".—.. . <br /> ---------- No. Compartments ......... <br /> Distance to nearest- Well ... .............................Foundation ...................... Prop. Line ....................... %P <br /> LEACHING LINE No. of Lines ............... Length of each line.---._..........--.__.__-._. !total Length ... ............I.I .......... <br /> 'D' Box ......i..:_. Type Filter Material .. .......Depth Filter Material ......................................... Ln <br /> Distance to nearest: Well ........................ Foundation ................ Property Line. ........................... <br /> SEEPAGE PIT Depth .... :..4........ Diameter ................ Number .................... Rock Filled , Yes 0 • No 0 <br /> • Water Table j Depth ----- ........................ ........Rock Size ................................. <br /> Distance to n'earest.. Well ..:.....................................Foundation ------------------- Prop. Line ...................... <br /> REPA'IR/ADDITIONJSJPrev. Sanitation Permit# .... ....... ................................ Date ......... _---_-_---------------- <br /> -_--------------- <br /> Septic Tank pecify Requirements) <br /> Disposal Field (Specify Requirements) ........... ----------------_---- ................... .............................................. ------ ......... <br /> ------------------------------------ .................................................... -----------­------------­- --------......................... <br /> 7,- <br /> .........--•..... ........................ ...............I----•--------------.--................-----------•.......--•---...-•----. .............................. --------- <br /> (Draw existing and required addition on reverse side)' <br /> I hereby certify that I have prepared,ihis application and that the work will be done in'accordance with Son 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 th'4-­w*'rk-for which this-permit I i6llil6l-emp-loy any person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed .... --- ...................... .......... .......... ................. Owner <br /> By ......... ........... ..................... ............ Title -------------- ....................... <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY, .. •.. ............................ .................. DATE ..... _---------_- <br /> BUILDING PERMIT ISSUED .... ... ................... ........•-------•--.........:...:.--------------------=-=--...�­....!....DATE............................................ <br /> ADDITIONALCOMMENTS................._.............................................................. ..................................................I......_1-----_--------- <br /> ...........I......I........I.......... -------------------------------------------------------------------------------------------------------------------------------- ..................... <br /> ------------------------------------------------------L................L.............__L.................................. ................* <br /> .............................. -------------------------------------------- <br /> ................ ............... ................. <br /> . ................................ ............................. <br /> .....................Date ........................................... <br /> Final Inspection by: .... ... ... ..... .......................................L.............I....... <br /> SAN J OAQUIN LOCAL HEALTH DISTRICT <br /> w 13 24 1 v.. --;AA 7/72 3 X <br />