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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> 7/3 <br /> (Complete in Triplicate) Permit No. ___7__ ------ <br /> - <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 Ordinance No. 549 and existing Rule and Regulations: <br /> JOB ADDRESS/LOCATION . J, --- - 1f _ fl_/ f?ffl�` ISLACT <br /> Owner's Name --Phone Ylu--t-� �------ <br /> Address l Q C --------- s�//Zn/__-- ----------------------- City 114-011" 1� -------------------------- <br /> t <br /> Contractor's Name ...--tl -- ----- License #o � Phone <br /> Installation will serve: Residence ER Apartment House-E] 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 AT <br /> Character of soil to a depth of 3 feet: Sand tK Silt❑ Clay ❑ 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 I ] Size------------- -------------------------- ------- Liquid Depth ---------------------.----- <br /> Capacity ------------------- Type --------------------- Ma rial---- - ---- No. Compartments ------ ............... <br /> Distance to nearest: Well ------------------------ -_-------Founda ' n ---------------------- Prop. Line --_.--------_-------- <br /> � <br /> LEACHING LINE [ ] No. of Lines ------------------------ Length of ach line-------- ----------- ----__ Total Length -----------------•----------p <br /> 'D' Box ------------ Type Filter Material ------_--___-__-De h Filter Material ---------------------------------- -------� <br /> Distance to nearest: Well --------------- -------- Foundati n ------------------------ Property Line ------------------------o <br /> Depth De <br /> SEEPAGE PIT <br /> L l p Diameter -- ------------- Num r - Rock Filled Yes ❑ No i❑ <br /> Water Table Depth ----------------- ------------------------ ----Rock Size -------------------------------- <br /> Distance to nearest: Well ------ ------------------------ -------Foundation -------------------- Prop. Line ...............-.----. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ---------- ------------------------- ------- Date --------.---_----_--_--_____------) <br /> Septic Tank (Specify Requirements) ----------------- - ----- -----------------------------------•------/------------------�---•--- ------------------------ <br /> /� � 7'. <br /> Disposal Field (Specify Requirements) ------ ---------f d --------- -_ o`6 ------------- <br /> '' ----a---- -------------- <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, I shall not employ any person in such manner <br /> as to become subject to Workman's pen$ation laws of California." <br /> Signed --------- 1 Owner <br /> By -------- ---- <br /> (!f other than owner) Title <br /> --- ----------------------------------- <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------------------- --- - --------------------------------------------- -- '�1 --•--------- <br /> -------------- DATE ---- ---------------�•-- <br /> BUILDING PERMIT ISSUED ------- ------------------------------------------------------ --------------------DATE -------------------------- ---------------- <br /> ADDITIONAL COMMENTS -------------------- -- -------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------- <br /> - ------------------------ <br /> - - - - ------- ---------------------- <br /> Final Inspection by: -------------------------------------------------------------------------Date - 1-- ---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev, 5M - <br />