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Urrttx t.rst:: APPLICATION FOR SANITATION PERMIT <br /> �.! ........ �C -C�i <br /> /� ICompleto in Triplicate) Permit No. .................... <br /> 9... --------------------- <br /> Date <br /> This Permit Expires 1 Year From 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 /> descri Tl�.s onnlic¢tion is made in compliance with County Ordinance No. 549 and existing Rules and Reguliationst <br /> t . ..... ENSUS TRACT <br /> �_.........-...._.......JOB ADDRESSAOCATIO ti. <br /> Owner's Name C `fJ�f� .................... ... . ....................................Phone <br /> skddress ........ r °r. 4p{ � .......................... City ........................ ....... <br /> Contractor's Name �. .. ... .... � �.. #! rte .... Phone ..............�.��..... <br /> Installation will serve, — Residence&Apartment House,] Commercial OTrollw Court 0 <br /> Motel Q Other >C/ ... .... <br /> �. ............................................ <br /> Number of livl. units:__ d <br /> ng E.... Number of bedrooms _.._._Garb ge in er t SFza .....I....... <br /> Water Supply: Public System and name .............................. ' ...................Private❑ <br /> Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ eat❑ Sandy Loam ❑ Clay Loam <br /> Hardpan Q Adobe;ff 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 serr is available within 200 feet,I <br /> PACKAGE TREATMENT ( ] SEPTIC TANK14 Size.. __ ......................... Liquid Depth ............. <br /> Capacity �.�� ...... Ty .... Materia �.. No. mpartments _.._ . <br /> Distance to np rest: Well .. ....Foundation L ... Prop. Line .4� <br /> ,-EACHING LINE No. of Lines .- ±.................. Length ..f each line.. .70`.............. Tota! Len .l ..�.......... <br /> 'D` Box ......1:.... Type Filter Material `���:....Depth Filter Material ....f. �r..................I........ <br /> ^p <br /> Distance to nearest x <br /> Well 14 ,Q?4 ..... Foundation .... .....�....... Property Lute .......s��............. <br /> SEEPAGE PIT Depth, -Diameter .tr. Number .....r...�........ /i/f . Rock FII ed Yes K No ❑ <br /> /�� r. ......:..,.........Rock Size j1&'Ir.� i <br /> Water Table Depth ----.. ..... ..... _... <br /> Distance to nearest: Well ......Foundation ,! Prop. Line <br /> REPAIR/ADDITION IPrev. Sanitation Permit# -------------------------------------------- Date ) <br /> SepticTank (Specify Requirements) --------•------...._..................... ........................................-----•..............._. .............................. <br /> DEsoosol Field (Specify Requirements) ..............................................................................•--------------.....------............._••--- -•---- <br /> ............... ......... .................•-------•------------------- •-----. --- ........ ................. ... ... . ... <br /> . . ...-----------------------•-----...................... ...... ..............................._........._..-•-...................................................................................... <br /> . <br /> {Draw existing and required addition on reverse aide) <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. Hone 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 subiectrto�Wor�kman�oCompens tion law of California." <br /> -------------------- <br /> By ........--. :�.. . .. ... .. ..................................................... <br /> y .. .. ................ <br /> (If other than owner! <br /> F DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .... . - .... . DATE ..../ ;� ...:y .•....`: <br /> .................................. <br /> BUILDING PERMIT ISSUED DATE------------------ <br /> ADDITIONAL COMMENTS ............................•------•----------------------- <br /> ......--.-..—--------- ----------------•- --------.............--........................------............. ---•-----------. <br /> 't 4j-7t....._ : (fit ---------- ................ ....... ..---.... ...... ....-... ................................... <br /> 9 <br /> Final Inspection by: .. ......- Date .. <br /> ......................... <br /> M 13 2!I 1--66 Nev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 9 ' - 8/7h 31'9 <br />