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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT -113 <br /> r <br /> Permit No. <br /> 7................ <br /> '"'"•"'•"'"""•"'-•-'`�. . '.---- (Complete in Triplicate)-...... .............................. . Dote Issued , <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 application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations: <br /> ..---CENSUS TRACT ..............:------- <br /> .... <br /> JOB ADDRESS/LOCATION";,�.O-9' .�-7...9,... . ...................... ... <br /> Owner's Name .........84V-- <br /> V- ..wt..&lJ. fs� rv. ----------------­-................. Phone .... <br /> Address •-•• Cit ..:.......... ................................ <br /> Contractor's Name -- - �" /� ----.License # ........................ Phone ......................... <br /> s�.�rL.Y.-..i...--..... - ------- <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 /> n Private ❑ <br /> Water Supply. Public:5ystem and:name ..- ... ....-•------------ �;.... ......................... <br /> Character of soil to a depth of 3 feet. . Sa d'❑ -silt-0--Cloy ❑ 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 /> E NEW INSTALLATION: INo septic tank or seep a pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANKfW TANKSize......::---------- ---------------"............. Liquid Depth ------- ................ <br /> Capacity �2AJ. .. Typ - �'" :-- Ma#eria) ---- o. Compartments .- -...............B <br /> Jr <br /> Di tante to nearest. Wel[ .,......---.......--------Foundation ... ............... Prop. Line ...........J <br /> LEACHING LINE No. of LinesLength,o•f each line.._ _. - Total Length .J.Q.�?.................. <br /> /y.. i <br /> 'D' Box �'..- Type Filter Material '------�---- <br /> Depth Filter Material ...--.-- ---• Rt <br /> * Distance to nearest: Well -. ��................ foundation � ..f""•-".. -- Property line ._.-�-... -•--:-• <br /> j SEEPAGE-PIT [ Depth ...l�f Diametef� <Xy' Number ----.-.-j--- ----------- Rock Filled Yes �No ❑r <br /> .----- .:. <br /> Water Table Depth _..--.. . .............Rock Size .....-..---- .--•- ----•• �p <br /> Distance to nearest: Well _...JW ..--.--.-..Ir ...........Foundation ---........".- ----- Prop. Line --. ........... <br /> REPAIR/ADDITION IPrev"Soniiation Permit# --------- ................. ---- Date --:"----- ------------------------ <br /> Septic <br /> .----- ---Septic Tank (Specify-Requirements) ---•- ------------- ............................... .........---.......... <br /> �rr Disposal Field ISpecify Requirements) .................... �` <br /> ----------------- . ---.... ._ ! . ... .- ...----...-. .---- ------ --•-----------• ... "----... .. ..........--... <br /> ` -------- �,-----""...... ------•---------•-•- ----"---= <br /> I - f.- <br /> (Draw existing and required addition on reverse side) <br /> thereby certify that i have prepared this application and That the work will be done in accordance with San Joaquin <br /> County Ordinances, Stare laws, and Rules and Regulations of the San'Joaquin Local Health District. Home owner or Licen- <br /> sed agents signature certifies the following: <br /> l "1 certify that in the perfo mr ane of the work for which this permit is issued,'I'sheill not employ any person in such manner <br /> as to become su//b�-'� � to Workman's Co�fI ensation laws of California.';,,,,.�—�x. , <br /> Signed .... L/k �..- 1 ------- ------ Owner <br /> OtA <br /> By ... <br /> .Title <br /> (If other than owner) <br /> l FOR DEPARTMENT USE ONLY _ <br /> APPLICATION ACCEPTED BY _. //_ff�� .. . --- --- ----- . tom........ <br /> CT� �T .4Y .. DATE . ............._ .. ._.-.- <br /> BUILDING PERMIT ISSUED ............ . ............ . ---.-- <br /> ' ADDITIONAL COMMENTS ----....'- . <br /> t - .._....... . . . ..• ... ---.--- .................. ........ •..-•----..............-. <br /> f <br /> ...................... .. .................. . .. -Date . - .. .e ----- <br /> . . --- <br /> Final Inspection by- ---- = - " <br /> # SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> b.. fl.,. 7 72 3 M <br /> C., <br />