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q = fOR OFFICE A USE: <br /> 'APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------ ------ (Complete in Triplicate) <br /> Date Issued _� - =- � <br /> --------------- <br /> •------------------- <br /> b This Permit Expires t Year From Date issue <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> described. This app • <br /> a ._CENSUS TRACT ----- <br /> n <br /> JOB ADDRESS/LOCATION <br /> - ��"---------------=--------- ---- -------------------Phone ---------------- ------------------ <br /> Owner s Name ---- -�- - -�-�--�---- �-- - L��� <br /> 1 ------'------------ ------- City1� <br /> Address .------- --------- Phone <br /> r ial Trail - Pho <br /> --- -- - -- - ------ ---License � 1' - ------------------------•--- <br /> Contractor's Name ....__. '{• "� ' '� " " <br /> Installation will serve: Residence E] Apartment House Commerc ❑ <br /> Court l❑ <br /> Motel ❑Other -------------------------------------------- <br /> Oe-�'ea----------------- <br /> Number of living units:-.�� .- `Number of bedrooms ------Garbage Grinder "- .Lo# Size __----- <br /> I Q0----------'-------------------- <br /> mePrivate ❑ <br /> Water Supply: Public System and na -_�� _.... --- '�� <br /> Character of soil to a depth of 3'feet- Sand'❑" Silt.0 - Clay ❑ :'Peat❑' Sandy Loam ,❑ Clay Loam ❑ <br /> Hardpan ❑ -Adobee Fill Material ------------ If yes, type ---------------------------- t <br /> �i .• " Buildings, .e#c. must be placed on reverse side.J <br /> {Plot plan, showing size of lot, location of system in relation' <br /> to wells, <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> Liquid Depth --------------------. Ni <br /> PACKAGE TREATMENT [ ] SEPTIC TANK' Size----------------•-----=- q p <br /> - Material---------------------- No. Compartments ----------•---•--:. <br /> Type --------------- <br /> Foundation <br /> Capacity -------------------- Yp <br /> Foundation ---------------------- Prop. Line ----------- ---------- <br /> r Distance to nearest: Well ------;"-�� <br /> t, <br /> Length of each line--------------------------- Total Lengt ,.__--"--- <br /> LEACHING LINE ri No. of Lines ..___..__.-. <br /> ---De Depth Filter Material ---------- ---------- <br /> 'D' Box .----------- Type Filter Material ------------- P "y <br /> r --------Foundation ---------'-=------------ Property Line ------------ <br /> SEEPAGE PIT � Depth, ------------- ----- Diameter --------"---- -- <br /> ------------- <br /> Water Table Depth --------------- ---Rock Size <br /> r - <br /> Foundation ----- -------- ---- Prop. Line ---------------------- <br /> Distance to nearest: Well ------------------- <br /> --------- <br /> I <br /> f -- <br /> •-----i <br /> I -------------------------------------- <br /> 0 <br /> Date ------------- <br /> ----- --------- <br /> REPAIRJADDITION(Prev. Sanitation Permtt - ------�--- ---=---- -------- - <br /> l -- -----� i ,�- <br /> Septic Tank (Specify Requirements) -_-- <br /> Disposal <br /> Field (Specify Requirements) - �-------e �----- - <br /> I Joy /� x< --- ------ <br /> ------------- <br /> -------------------------------------------------------- -----------------------ed a - -- e -- <br /> {Draw existing and required ad ition on reverse si e <br /> I hereby certify that 1 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 liven- <br /> ' sed agents signature certifies the following: <br /> "I certify that in the performance;of the work for which this permit is issued, l shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ------=-------- 'y -------- Owner <br /> --------------- ---- -----:---- - <br /> /Z�- :--- ----- ------ <br /> C�------------------- <br /> - ---------- - Title ---- --- ---- ----------- <br /> (if other t owner) , <br /> PARTMENT USE ONLY ry <br /> APPLICATION ACCEPTED BY -------- -- ----- - ---- ------"------- " <br /> DATE . /&� ------yQ / f --------- <br /> BUILDING PERMIT ISSUED ---- ---- - ------- --------------------------- ---------------- <br /> DDITIONAL COM S = - - --- ----------------- -- -- ---- --------- <br /> --- ---- <br /> -�. _'7 v ---------------- ' <br /> ------------- ---- 1---- -- ------ - -- - ------- --------- -------------------- <br /> ------------- -------- ------------------------------ Date <br /> -. - XX <br /> Final Inspection b <br /> I SAN JOAQUI LOCA' HEALTH DISTRICT <br /> s <br /> E. H. 9 1-'68 Rev. 5M <br />