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FbR OFFICE USE: <br /> t APPLICATION FOR SANITATION PERMIT (,[ <br /> O (Complete in Triplicate) <br /> Permit No. 9.3_--_�.6>S <br /> _______________________________ ________________________ This Permit Expires 1 Year From Date Issued <br /> Date Issued 3 <br /> __ <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 /> 6 QS <br /> JOB ADDRESS/LOCATION __ -�t©_� _,_-/ __ _______:.____..____-_.-----CENSUS TRACT -------------- ........... <br /> Owner's Name ---/ �-/�------R/91/c/ �'----4 --------------- -------Phone . T <br /> Address __1A,'2 r-----J* wt1 f l_ai--------------------------- Cit t ------------- <br /> Contractor's Name --- rt - - -/--/ ------License 7. _ Phone �^• <br /> Installation will serve: Residence &Apartment House❑ Commercial ❑Trailer Court ;❑ <br /> Motel ❑Other ------------------------------------------- <br /> Number of living units:__________ Number of bedrooms ------------Garbage Grinder ------------ Lot Size --- <br /> Water Supply: Public System and name ---------------------------------------------------------------------------------------------------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sandg Silt❑ Clay-Eq- Peat❑ Sandy Loam ❑ Clay Loam <br /> Hardpan ❑ Adobe ❑ 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 permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size_-_______ _______________________ ______ Liquid Depth -____------_________------ <br /> CapacitY ------------------ Type -------------------- M erial----- ------ -- ---- No. Compartments ...................... <br /> Distance to nearest: Well _____________________ ______________Found on ---------------------- Prop. Line --------------._ 0 <br /> LEACHING LINE [ j No. of Lines ------------------------ Length each line----- --------------- ------ Total Length ,___________________________ 0 <br /> 'D' Box ------------ Type Filter Mat al _-___....__--__ epth Filter Material ____________________________________________ 0 <br /> Distance to nearest: Well _____ __________________ Fou ation ------------------------ Property Line ________-.-_-___-.._....,/ <br /> SEEPAGE PIT [ ] Depth -------------------- Dia ter ______--_--_-_ umber ___________________________ Rock Filled Yes E-] No03) <br /> Water Table Depth --------------------- - ------------------Rock Size -------------------------------- <br /> O <br /> Distance to nearest: ---------------- __-_ _.___. ...Foundation _____________________ Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit ------------------- ______________________ Date ----------------------------------) <br /> SepticTank (Specify Requirements) ------------------------------------------------------------------- -•--------------------------------------------------------•-•--------•-- <br /> Disposal Field (Specify Requirements) _________________________________________ _ _ ____ -_-____ _____- <br /> -4-----fes W.... �i ------��c�---- - - -!�9----��------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------__ ^A <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- 6-Q> <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 o Work n's Compensation laws of California." <br /> 14 <br /> Signed = - ------------ - -- ---------------- Owner <br /> BY ----- -------- -- ---------- -------------------------- Title ------------- <br /> ------------- --------------------------------------------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --•----------------------------------------------- ----------- DATE ....... L7-.23---------- <br /> BUILDINGPERMIT ISSUED --------------------------------------------------------------------------- ---------------------------DATE ---------------------------------•--------- <br /> ADDITIONALCOMMENTS ------------------------------------------------------ ------- --------------------------------------------------------------------=--------------------------- <br /> ------------------------------------------------ ------------------ --------------------------------------------------- ------------------------------------------------ --------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------ -_ <br /> ----------------------------------- <br /> Final <br /> Ins ection b ----Date __.- _ _ <br /> SAN JOAQUIN LOCAL HEALTH DIS <br /> E. H. 9 1-'68 Rev. 5M <br />