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- FOR OFFICE USE: <br /> /N039 6catc, dt ., <br /> APPLICATION FOR SANITATION PERMIT <br /> -0 (Complete in Triplicate) 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�rcl r ce Np.�49 anpe fisting Rules and Re ions: <br /> ��p.tO�tra► � <br /> JOB ADDRESS/LOC ION , L __ 0_P�-- /±CRo�t+�--12�-----CENSUS TRACT <br /> Owner's Name ---------------------------------------------------- 1 ----------------Phone 2247.2-41F --- <br /> Address -----------------`3-0-A-0---� ` 'n� CitY � <br /> Contractor's Name ---- -- _ _ _ ___ IrC.___.License # .�l _______ Phone _4t_ ®s O� <br /> Installation will serve: Residence�Apartment Huse,❑ Commercial ❑Trailer Court ❑ <br /> Motel ❑Other ------------------------------------------- <br /> i <br /> Number of living units:---- Number of bedrooms .__-----Garbage G __________ Lot Size _Z-0 <br /> Number _-------------- <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 ❑ <br /> Hardpan ❑ Adobe'5�_ 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.) �A <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size_______________________________________________ Liquid Depth -_--_-_____-_--_.,-__-- <br /> Capacity --------------------- Type ------ Material---------------------- No. Compartments ...................... <br /> Distance to nearest: Well -_________________________________Foundation ---------------------- Prop. Line -------------------_ <br /> LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length -------------_------------ <br /> 'D' <br /> ____-__-- _----___-_---'D' Box ------------ Type Filter Material --------------------Depth Filter Material --------------------_---------_............. "V <br /> Distance to nearest: Well ------------------------ Foundation ____ ------------------- Property Line ........................ ��' <br /> SEEPAGE PIT Depth ___________________ Diameter ________________ Number ------ --------------------- Rock Filled Yes ❑ No i❑ <br /> Water Table Depth -------------------------------------------------Rock Size -•-----------------•-•--•------- <br /> Distance to nearest: Well ------------------------------ ------- _Founclation __________________ Prop. Lime---.-____----__--- _.-- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------- Date ______-__-_-___-________._-____) <br /> Septic Tank (Specify Requirements) ------ ------------ --- --- -------­---------- -- ---- <br /> Disposal Fiel (S ecify qu'rements) - ---- -------- --- -- <br /> - --------------------------------------- <br /> (Draw existing a req i d addition on r erse 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 s' nature certifies the fol ing: <br /> "I certify t at in the performance f e work for which is permit is issued, 1 shall not employ any person in such manner <br /> as to beco a biect to.,W rkm am nsatk n la of California." <br /> r <br /> Signed ------ ---- -------------- -- - ---- --------- -- -- ZZ ------------ Q rrmy <br /> BY - - N Title Al ------- <br /> ------ <br /> (If other than owner) <br /> FOR DEPARTMENT USE O LY <br /> f <br />-: APPLICATION ACCEPTED BY . - ---- <br /> ------ L �'�` /DE <br /> (-- <br /> BUILDING PERMIT ISSUED --------------------------------------------------- --------- -------- - --- ------- ----------------------------------- <br /> ADDITIONALCOMMENTS ------------------------ ------------ -------------- ` --------------------------------------- ----------------------- <br /> ------------------------------- ------------------ <br /> ------ ------ - ----------------- <br /> ie -------------- -� <br /> Final Inspection by: ---------------------------------------------------------------- --- _. .� _ -----Date " ' --- --� F ---------- <br /> SAN <br /> - ------ <br /> SAN JOAQUIN LOCA EALTH" <br /> E. H. 9 1-'68 Rev. 5M <br />