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. ...... . <br />Final Inspection by• <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />flnt <br />3 ......,--. ...... .. . ----,„„ _..., ..,,,..7-0- <br />FOR OFFICE USE: <br />........... • <br />/6..aoc> •-11. <br />APPLICATION FOR SANITATION PERMIT <br />Complete in Triplicate) <br />This Permit Expires 1 Year From Data Issued <br />Permit No. 2e- <br />Date Issued a" <br />ApplicaVon is here-by mode to the San Joaquin Local Health District for a permit to construct and install the work herein <br />described. This application is mode'in compliance • h County Ordinance No. 549 and existing Rules and Regulations: <br />CENSUS TRACT <br />.04 <br />Private <br />t <br />'D' Box Type Filter Material . Depth Filter Material <br />Distance to nearest: Well , Foundation Property Line. <br />SEEPAGE PIT [ I Depth ...`.... ... ...... Diameter . Numbe- Rock Filled Yes 0 No 0 <br />water Table Depth 1. Rock Size ........ ... „ . . . ,......._.... ..... <br /> Foundation Prop. Line ., <br /> _i - Date ....... ....... .... ..—..................) <br />•••••••,.-. <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 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 <br />as to become sublect to Workman's Compensation laws of California." <br />_(Draw existing and required addition on reverse side), _ _ <br />Owner <br /> <br />person in such manner <br />.. :Title <br />FOR DEPARTMENT USE ONLY <br />• <br /> APPLICATION ACCEPTED BY Y. <br />BUILDING PERMIT ISSUED <br />ADDITIONAL COMMENTS <br />16- <br />JOB ADDRESS/LOCATIO 4,4. .40, <br />Owner's Name <br />Address .. -- <br />Contractor's Name <br />Installation will serve: <br />of living units: .f.....Number of bedrooms ,3......Garbage Grinder Lot Size <br />Number <br />Water Supply: Public System ana-nome — - <br />Character of soil to a depth of S feet: Sand 0 AlIt0 Clay [-1 Peat 0 Sandy Loom ° Clay Loam 0 <br />Hardpan D. sr. .i_ Adobe _ Fill Material : If yes, type • - . <br />ti of .system in relation to wells, Lildings, etc. must be placed on reverse side.) <br />(Plot pion, showing size of lot, locaon <br />... ...... *.• „. ... License Phone <br />... . , <br />Residence Apa 0 rtment House Commercial °Trailer Court <br />Motel 0 Other . <br />.1 Phone <br /> 'City <br />Distance to nearest: Well <br />REPAIR/ADDITION (Prey. Sanitation Permit # . <br />Septic Tank (Specify Requirements) <br />D- o1 Field .(Specify Requirements <br />\-1._ 0 <br />Signed .. <br />By ... . <br />(If other than owner) <br />DATE ....'..2. <br /> ,DATE DATE <br />NEW INSTALLATION: 0\10 septic tank or se'epage pit permitted if public,sewer is available within 200 feet) i (41• 4 <br />PACKAGE TREATMENT [ ] SEPTIC TANK j ) Size . .. „.. . .. ...... „....„........ ...".. Lieluid Depth ,.' <br />i. <br /> <br />Capacity 1 Type t <br /> - Material . <br />No Compartments . <br />Distance tb <br />nearest: Well ._ . ... t . .. ... . . ..... .t ... ,Foundation'...:.:1„......,-..1..... Prop. Line ...... . .. ---,...... <br />LEACHING LINE [] No. of Lines ...... . „ .... .A......-Lengthiof each line Total Length <br />_ . <br /> <br />, .-- - - i'•*" - : <br />el.NoE.H.9 1-68 Rev. 5M.