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FOR OFFICE USE- <br /> APPLICATION FOR SANITATION PERMIT <br /> _ .. (Complete in Triplicate) <br /> Permit No. ..................... <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 /> JOB ADDRESS/LO TION /f�� .. ..._ :. � 1 .......90_._........ <br /> / ....................CENSUS TRACT .......................... <br /> Owner's Nom f-"".. �' /C - 12 o 3 "-�11 <br /> ,//�� ". .............. ..............................---"---...... •-------....-•-..................Ph home ..... .. <br /> Address .."_ .f R�.. :..... G..... . 5 T . /Ll City - !?/ '.0-4, <br /> me "...SQL <br /> /C.__. <br /> Contractor's Na .._....__..._..."•.License # <br /> ..........."---------------------- - -- �•-•--- Phone .............................. <br /> Installation will serve: Residence ❑ Apartment House,❑ Commer iol ❑Trailer Court ❑ <br /> Motel ❑Other . <br /> - ",� p <br /> Number of living units:......... Number of bedrooms ..{�----_Garbage Grinder ............ Lot Size . .- .... °� <br /> Water <br /> ic <br /> tem and <br /> Characterofsop tola desth of 3 feet n1eSand.........................ilt - ----••---•------------.._.-•-----.....-•......................•- ....................Private ❑ <br /> p ❑ ❑ Clay '0 Peat❑ Sandy Loam ❑ Clay Loam ❑ O <br /> Hard-`an • AdobeNg 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 permitte�ifu llc sewer is available within 200 feet,)PACKAGE TREAT MENT ( ] SEPTIC TANK Size �... ..............".. Liquid Depth .......7..y......_ <br /> CapaciType/Ir -------- Mater.ial.C�".__._._.. No. Compartments :_ . X� <br /> do­-­ /e <br /> := rest: Well f "... -•--- <br /> . Foundation .. _:.d".....:.-.. Prop. Line _�o ,Ci__--• I <br /> LEACHING LINE Not of Lines of e line.__- �,_.... _... Total Length <br /> ' D' Box <br /> ri <br /> .... Type Filter`Materiaf.. . _...Depth Filter Material ...` ................................. <br /> I <br /> Distance to nearest: Well ....... Foundation Foundation J.1,.._-",-__ Property Line ... ... <br />_ SEEPAGE PIT { ) _ Depth. -------- Diameter................. Number -- Rock Filled Yes ❑ No ❑ + <br />' t <br /> Water Table Depth -----------=---Rock Size _..:.....__. --------------- <br /> • <br /> Distance to nearest: Well .- :-- ......................Foundation ........ Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ..__......._.,:�... ) <br /> _ Date ......------••--- �- <br /> E4 Septic Tank (Specify Requirementsl,�'........... _~ .......... <br /> .---------•- -•... ........... ................................. ........................... <br /> Disposal Field (Specify Requirements) ---------- �---- ------ --------- ------ ------- ...._._...._, <br /> ... <br />"•'r. . .......................................... ................! <br /> - ............................................................. ............. ..... ................_... r <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 (icon- L <br /> sed agents signature certifies the following: M <br /> "I certify that the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to beco /sou jest to W man's m nsation laws of California." <br /> Signed . .. .----- Owner <br /> BY ...... ............. . ... - <br /> ................. .... Title <br /> . .............. . . ......_......."..._... <br /> (If other than owner) <br /> FOR DEPARTMENT USE. ONLY <br /> DATE <br /> BUILDING PERMIT ISSUED ... .. r. ® ATE ...,. .. t <br /> APPLICATION ACCEPTED BY .... ..-... <br /> ADDITIONAL COMMENTS .........._... ............................ <br /> ------------ ---------------"..----- --------- --..-. . . <br /> ..._.....-" . ........ ------- <br /> Final Inspection by: ---- Date ... .... ..�_�.7. <br /> �� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 13 24 t- eg ups _,AA , g <br />