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APPLICATION FOR SANITATION PERMIT <br /> oa <br /> (Complete in Triplicate)........................................... <br /> ; Permit No, ...�7-��....... <br /> """"' This Permit Expires 1 Year From Date issued Date issued ..�!./�,7 <br /> ......- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constructo d install the work herein <br /> described. This application is made in compliance %ivith County Ordinance No. 549 and existing^Rules and Regulations: <br /> JOB ADDRESSAOCATION ..../Q..9.'ef)'„_�,_,.� ell'” <br /> / <br /> �u O<<tl�l`../ �_.-..-..........CENSUS TRACT <br /> ell,Owner's Name ..��: k' .��.._.. .��a���.',w`/al....�..................................................... ; <br /> Address . Phone .................................... <br /> 1�Z�! --•........... . ......... City r..?.> QG�lMf�'i <br /> Contractor's Name`.-'•j����--"��''�--�f�..1.0-�� . -....--•................................... <br /> .............................••....License #, 1'� �3 Phone XJA__ '�,G�� <br /> Installation will serve: Residence Am <br /> Apartent;House fl Commercial (Trailer Court 0 <br /> Motel ❑Other .......:.!.................................. <br /> r <br /> Number of living units .1.:.':... Number of bedrooms s?...._..Garbage Grinder/. .... Lot Size <br /> �. �, �� ........... <br /> Water Supply: Public System and name ..................... i <br /> Character of soil to a depth of 3 feet: Sand❑�'_Silt❑ ClayEDPeat_❑ Saridy Loam [] •. Clay Loam (:] <br /> Hordpon Adobe.0 Fill Material ...- :. If es ' <br /> ' � yes, ...:........................ <br /> (Plot plan, showingjsize 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 <br /> ( ] SEPTIC TANK ] Siz®.......................... 1 _ Liquid Depth <br /> I Capacity .................... Type ............'?,--. Material.--.......... # ..... No. Compartments <br /> z .. <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 Materia! ......................... <br /> Distance to nearest: Wel! ----------------_----- Foundation -" <br /> Property Line <br /> SEEPAGE PIT [ ) Depth ..................... Diameter-.....:.:.:...:.: Number ..:---. ...........- `Rock Filled Yes [) No <br /> Water Table Depth .....Rock Size <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit'# ............................................ Date ) <br /> Septic Tank (Specify Requirements) ----- ............. .. -.----.-.-..--_- r <br /> Disposal Field (Specify Requirements) /* <br /> .............. <br /> a> `►� p� r <br /> V ,•. <br /> ......... ............•-.............-----••---•---......._...--•---.................. .-----••-•-------.....................-•---..............--._......._..................--•--•. <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certify that .l 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 of California." <br /> Signed ........ ..... ...... ..................... Owner <br /> By ................ ... . - . `.-Xitle ..;., <br /> ( f other t an owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ..................... '.._._._.......__...:...-...........__......------....•••........_ . . DATE .......d.- v_.. �11�.. <br /> BUILDING PERMIT ISSUED .... 3;..................................:..... ... ...DATE .-......................................... <br /> , ADDITIONAL COMMENTS ..................................................•....:: <br /> ......---:............•..............•--......._.......... <br /> ......---------•---- <br /> ..................................................................:......... <br /> .... <br /> ............... ........-......... / <br /> ...... ....... <br /> Final Inspection by. ....:........ Date <br /> �: '- --: ..�. ... U ...................................... .....4_: :.:z ':.... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />