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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit <br /> -------- ---------- --•--- •--......--.. . <br /> --- No. .7__Z.•..$_g.�. <br /> (Complete in Triplicate) <br /> Date Issued <br /> ._.------------- --- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the S n Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made i�.compliance wi ounty Ordinance No. 549 and existing Rules and Regulations: <br /> .S-y- --..--.-•.---- <br /> JOB ADDRESS/LOCATION �O� -- J ................ CENSUS TRACT <br /> n <br /> Owner's Name ....-- --.Pho e ----------- --------•----------•---- <br /> Address --- .._.. .._.//�cC! - 4..... - •-•-- - City - - <br /> / r, <br /> - a-9, '--.License <br /> Contractor's Name # �C-! ✓z Phone .... <br /> Installation will serve: Residence Apertment House-F] Commercial ❑Trailef Court 0 <br /> Motel ❑Other .. --•.-/ ^ <br /> Number of living units-....1----- Number of bedrooms ._�...Garboge Grinder -----------. Lot Size . ...... _._-__..__.__.._ <br /> Water Supply: Public System and name .------_--_. - --------------- Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam D <br /> Hardpan;� Adobe ❑ Fill Material ............ If yes,type ---------------------------- <br /> (Plot <br /> __.................._---- <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 sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK i ] Size_.4�1.�'`_._X_._/. __�r____--. Liquid Depth --_....- .-.____. O <br /> II <br /> Capacity 1.�B Type _____ Material_._ -••.• No. Compartments ----a�_--------__ Q <br /> -------- - <br /> i <br /> Distance to nears t: Well _---._.._-577,' ? - - ----------Foundation -----/.Q..- ------- Prop. Line ...................... <br /> LEACHING LINE * No. of Lines ..._....o --- Length of each line---._._... 4� ........ Total Length ....elP--------------- <br /> 'D' Box _..._�..._-_ Type Filter Material ----SAP,_.- Filter Materia) ....._.�.�._�� ..._5---------------•- <br /> Distance to nearest: Well ..-- ........ <br /> Foundation ......l.Q_....- Property Line _-- -------__-_------- <br /> SEEPAGE PIT Depth --.. Diameter ----- _ .f. Number ..... ..___ Rock Filled Yes [X No C3 <br /> Water Table Depth ----------------k------•------ -------------Rock Size -- /� X -�..... <br /> Distance to nearest: Well ------I.J9.V ------------Foundation __.1 ........... Prop. Line .-...5___--_._... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ...-_-____-..-__.-..-_----_.-__---) <br /> Septic Tank (Specify Requirements) -------- _--- -- --.----•-------•---- ------ --•----------------- ----------............------ <br /> Disposal Field (Specify Requirements) .._.-----: -- _------------------- ----------------•--- ------ - ------- <br /> ------------------------­--­--­­..­---------------- <br /> ------------ ----••-------------------_...------------------- ------------ ........................................ <br /> --------- ------------------­---­-------- - -------- -------- <br /> -- ------------ .......... ------- ----- <br /> - <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 licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed -------------------------------------------- <br /> Owner A cpd? <br /> . . .- Title ... .... <br /> ------------ ..------ <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY . __-. DATE ..J -.• - -� Z•••--- <br /> BUILDINGPERMIT ISSUED ............................ ...............................................DATE ----------•----------------•--------.... <br /> ADDITIONALCOMMENTS ..................... ......................................... .................... ------•-•---------•-------------------------- <br /> ------------••--------------••-•------ ......................................... ----•------•--.. ..-----------••-----•----••-------------- <br /> . .... ..................-•-------------------- -•-------------------------•--------- <br /> Final Inspection by: ....-- ----....••-••--------------------------Date ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />