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FOR OFFICE USE: APPLICATION ICOR SANITATION PERMIT ` <br /> .................................................... <br /> ..... Permit No. .��_`-�--:� <br /> (Complete in Triplicatef <br /> This Permit Expires 1 Year From 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 applielp i; mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LCtCA�ON.�. ... CENSUS TRACT ..._. <br /> . ................ <br /> Owner's Name .... ._ <br /> ----------.-y...... .:�!�� _p.. ._._......--•- •,• .............. ... .....Phone ................._. ............. <br /> Address .......... . 1. ........ .r ------ ............ ........... Ci ...: .......................•--........--•-•---....-------- <br /> Contractor's Name -.2�. �._.� - ?---�/ .........License 0 Phone .............................. <br /> Installation will serve: Residence[!'Apartment House!] Commercial QTrailer Court. 0 ' <br /> �.! <br /> Motel El Other... <br /> ......................................... , <br /> Number of living units:.... Number of bediooms-. /---...Garbage Grinder ............ Lot Size �� - .......... <br /> Water Supply: Public System and Hama ............................................•........... <br /> ...----------- ------------.........................Private <br /> Character of soil to a depth of 3 feet: Sand Q Silt❑ Clay Q Peat Q Sandy Loam❑ Clay Loam O <br /> Hardpan Adobe Q Fill Material ............ If yes,type............... ............. <br /> (Piot 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 f-1/ Slze_S.. 1. ..r.�I...1r...`............ Liquid. Depth ...-',z.................. <br /> T Capacity i!-e-4 __....... Type f2'�Material___- n ..r. No.` `6ompartments ............. <br /> Distance.to nearest: Well .............5 ..................Foundation -----(.4_........... Prop. Line ... 5............... <br /> LEACHING LINE {'j No. of Lines ..3--------------- Length of each line.-----.�..�_-......... Total" Length 1 <br /> .... _. ----- _/gip... ............... <br /> 'D' Box .__— .... Type Filter Material .....Depth Filter Material ....../.•?..................•___.__.... <br /> Distance to nearest: Well .....-Th. ....... Foundation Property Line ............:..... <br /> SEEPAGE PIT Depth ...-2- ...�.. Diameter /1 <br /> Rock Filled Yes [ No � <br /> P •...•• . Number -•-----•----3...--- <br /> Water Table Depth <br /> Rods Size 3 ",�'/ <br /> Distance to nearest: Well ----- --1G'C2 ....Foundation ....15!-. Prop. Line <br /> .................. <br /> REPAIRJADDITION(Prev. Sanitation Permit# ------------------------------------------ Date .........:.................. <br /> _____-} � <br /> SepticTank (Specify Requirements) ----------...................................................................... ......................... -•.......................... <br /> Disposal Field (Specify Requirements) ........ ------ .......................... --•-•------••---•------•--•-••--••-- -----------=---------------=•-----•- ..... <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, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed --------------- -------------- Owner <br /> ------------------------------------------------ <br /> ------ L _ Title _ ---------------------- <br /> (if other than owner) <br /> _ _ FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _... ... ---------------------------....... DATE . . -- • ------------------------ <br /> BUILDING PERMIT ISSUED ------------ ------- <br /> - -------------------•-•----....--•-----------------------------------------DATE ==-----:.._::....<._._._. <br /> ADDITIONAL COMMENTS •----------------------- -------- <br /> --- - -.......:.._..... <br /> •------------------------•-•--------------------- ----•------• --•- ----------------•-• --•--------•----....------------....-----------------------------._...._..._...... -•----------------------- <br /> ---------- -----------------------—..---- -- _.. <br /> Final Inspection by: ..-- -•--- '�-- .-:.. Date .. _/..f •-------- <br /> EH 13 24 1-68 Rev. � AN .JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />