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FOR OFFICE USE: <br /> ...............`r' APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> (Complete in Triplicate) <br /> .................................... .... <br /> ................ ........ This Permit Expires t Year From Date Issued Date Issued ... <br /> Application is hereby made to the San Joaquin Local Health Disrtct for a permit to construct and install the work herein <br /> described. This application ism a in compliance with County Or inance N 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ---------------- ............................. ........ CENSUS TRACT .......................... <br /> Owner's Nome ... ..:....~....Phone _ .. <br /> Address .............. _H.l'1'1.�... ................_................... . -- .,_.... CitY . <br /> Contractor's Name ---9Dv. .e:1 6 L.e�L.>�+IE ---.---- ...............=------=-------License # --=----- ---........---• Phone ---....................... <br /> Installation will serve: Resid u?eApartment tHouse0 Commercial :❑Trailer Court' ❑......................... <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: Sand❑ Silt❑ Clay! ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ r <br /> Hardpan ❑ Adobe.n Fill Material --------- If yes,:type ..................:......... � Q4 t <br /> (Plot plan, showing size of. lot, location of. system .in _rela#ion _to wells, buildings. etc. 'must .be placed on reverse side.) d <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 - ... . <br /> P Y ------------ TYP® ................ Material----------=------:.._. No. Compartments ................ ,. <br /> Distance to nearest: Well ....................I.__._.._._...-_._Foundation ......... ------------ Prop. Line ......- .......... <br /> LEACHING LINE_ No. of Lines _:__.._-/ ..;..__..F_ Length o each line.........z a.:�.___._. Total Length -__---S V..�...... <br /> 'D' Box ..... <br /> ----- Type FilterMaterial :.Depth 'Filter Mdterial __..1.. ......... <br /> Distance to nearest- Well 1 O:r---:. Foun otion ........-1-i..... Property line .......�.L� .... .r <br /> SEEPAGE PIT Depth Diameter .... Number :........ <br /> : ----- ....��.____.``.Rock Filled Yes Df No <br /> Water-Table Depth f ........Rock Size <br /> Distance to nearest: Well .... .!...........:........Foundation ----ZX ----- Prop. Line ........./_a...... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# Date <br /> _........ ` ._..F._.._ ... .............. .I <br /> Septic Tank (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'Son� Joaquin <br /> County Ordinances, State Laws, and Rules and-Regulations of the San Joaquin' Local Health.Dishict. Hamebwnor or licee-' <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 be ome ub ct Workman' Compen on la sof California." <br /> Signed s......---.. .d . <br /> BY _ ....... <br /> N _ ........ Title .................................... <br /> 3 <br /> other than ow rl _ <br /> FO EPARTMEN SE ONLY <br /> APPLICATION ACCEPTED DATE :.... _��� <br /> .. .. ......... -- ----- ............ - .......... <br /> BUILDING PERMIT ISSUED ...... ......,../:.er-:'.:�: = ...-::--...... . .-------•- ..... ... ............ <br /> .___.. ..: .. . ..:: .,...DATE <br /> ADDITIONAL COMMENTS ., _ , ........................... <br /> Final Inspection by ...:.. _..Date <br /> -. .fit_. . <br /> QUIN LOCAL HEALTH: DISTRICT <br /> E. H.13 24 1-'68 Rev, 5M 7/72 3 M <br />