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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> (Completeln Triplicate) Permit No. .....r-.,75 <br /> ...................... ....... ....... <br /> This Permit Expires t Year from Dote issued Dote issued lf?. � ; <br /> c,G <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 I in compliance with County rdinance No. 549 and existing Rules and Regulations: <br /> JOB ADD I N`L_. .._-'- .....__......... .._.. .... ...o���� ... ........CENSUS TRACT ................ :... <br /> Owner's Name . � -�-" Phone . O V........--- <br /> S --------- ,�. , .. .-, . <br /> Address .-------------------- -7._.. .-'. -... .. City -..... .. - _,-._........................- ---..._ ----------- . <br /> // .. <br /> Contractor's Name __.. _ ✓.....................License J.T-J.`1�J..... Phone 7�i6.7& ........ <br /> ................... -------------- <br /> Installcation will serve: Residence❑Apartment House 0 Commercial OTraller Court 0 <br /> _ a <br /> Motel ❑Other.�-_4 1_4...I... 62.V".0 <br /> Number of living units------------- Number of bedrooms Garbage Grinder Lot Size ' <br /> Water Supply: Public System and name Private <br /> Character of soil to a depth of 3 feet' Sander.Silt_C]Clay �0 Peat❑ Sandy Loam Clay Loam <br /> Hardpan Q Adobe ❑ Fill Material ............ If yes,type <br /> ]Plot plan, showing size of lot, location of systema in r"e"lation to wells, buildings, etc, must be placed on reverse side.) +' <br /> NEW INSTALLATION: (No septic tank or,seepage`pit.perm€ttecl if public sewer is available within 200 feet,] <br /> PACKAGE TREATMENT ] SEPTI' � ^. ' Slze-- ----- I-- - -------•---.-------- Liquid Depth ............... <br /> Capacity •Typ e... Material_ t'r.-.__ No Comportmentsr.`'................... <br /> . <br /> Distance.to nearest: .........._.Foundation ---IQ._.... ... Prop. Line_. <br /> LEACHING LINE pQ No. of Lines -----r NLength of each line......./Q0.............. Total Length ....14b................ <br /> 'D' Box ..__.!�___ T e Filter Materia( _ t!....De. th . <br /> Yp Filter Material .p '............................... <br /> Distance to nearest: Well -----------b...Y------ Foundation ......... ."t`.__.. Property Line .. ' <br /> . ._.....----..._.. <br /> SEEPAGE PIT [ ] Depth ....... ............ Diameter ................ Nurr bei ---------_--------------._ Rock Filled Yes ❑ No {] <br /> Water Table Depth --------------------------------- ------••-1....Rack Size .-----_--------- _--- <br /> r <br /> Distance to'nearest� : Well ........ ..............................Foundation .................... Prop'. Line ....----.----_..-----. <br /> � t <br /> REPAIR/ADDITION(Prev. Sanitation lPermit# ........------------•-----------...___------ Date -----......................... <br /> -_--) ; <br /> SepticTank (Specify Requiremenfs) -------------------------------------- -- ----• ....... •------•--- •---•----- ............................._.._................. <br /> Disposal Field (Specify, Requirements) ..................t ._.. ..._'_. -- -------------------------•----.----- I.......... <br /> -- � ---- s <br /> a, <br /> .. .. .. .................... ........... <br /> �.. (Draw existing and reciukecl additionon reverse side]­-.__ _ _ <br /> I hereby certify that I h v® prepar;id•`this pplieation 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 of 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 A. !! <br /> BY -------- .-----_------------ Title _...- � ------ ------ ---- ► <br /> (if ore-r-4tn owner) <br /> it FOR/DEPARTMENT.USE ONLY <br /> APPLICATION ACCEPTED BYDATE <br /> -BUILDING PERMIT ISSUED --------- <br /> ------ DATE .................... <br /> .. ...- ._... <br /> :. <br /> ADDITIONAL COMMENTS ._..----- --:'. ......... ------- -_..................... ---............:-------- .................. <br /> ---------- -------__...----.._.......---------•--....--• ........._......----------. . -------• --- -......................•........•................................................... <br /> ---------•---------------------------------------------_-�-.-�---------_-... <br /> .: _ �. .... <br /> ----- ------ -- --- ---------- --------_------ -- ` ---- ----------------- ------ J � . <br /> .........-.-.-. ------ <br /> ----------------- <br /> . i ----------------Date <br /> EH 13 2h 1-6€ Rev. 5K <br /> Inspection by: ------------ � SAN IOAQUINLOCAL HEALTH DISTRICT <br /> ..... i <br /> 8/74 3 <br />