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FOR OFFICE USE: P _� <br /> APPLICATION FOR SANITATION PERMIT <br /> .............................. <br /> (Complete in Triplicate) Permit.No. <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 Rules and Regulations: <br /> JOB ADDRESS/LOCATION 9,Z3. _..F-1.. V.. _.... ..........................................CENSUS TRACT .......................... <br /> Owner's Name ..... .L?.. .------ U. ..1----- ------------•--......._..............................................:. .......Phone ............................. <br /> Address ... ......... /..<.7�. 1 ..__ City / ?W ..................................:.. <br /> -v/ <br /> Contractor's Name ._. � Z./Le ...License *W-3 l.g....... Phone �� '�5.� <br /> - <br /> Installation will serve: Residence Apartment House❑ Commercial CTraller Court 0 <br /> ] Motel Q Other.............................I.............. <br /> Number of living units:...)------ Number of bedrooms _9::: Garbage Grinder ............ Lot Size ............................................ <br /> Water Supply: Public System and name ............... Private <br /> ...... _................................... <br /> Character of soil too depth of 3.feet: Sand I] Silt❑ Clay ❑ Peat.❑ Sandy Loom o 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: ( <br /> No septic t.ank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK I I Size............... ................... .'----- Liquid Depth .......................... <br /> Capacity .....--- Type -------------------- Mater'al------------ -------- No. Compartments ... .................. ^^. <br /> Distance.to nearest: Well ............................ .......Fou ation ...................... Prop. Line ...................... <br /> _ <br /> LEACHING LINE [ ] No. of Lines ------------------------ Length of a line.. ....•.................... Total Length <br /> D' Box ...�_.:._... Type Filter Material .... ............ ..Depth ,Filter Material ......................... <br /> Distance to nearest: Well -------------....- --.. Fou dation ........................ Property Line ........................ <br /> SEEPAGE PIT ( I Depth .....--------------- Diameter ._... ......... umber ........... ........ <br /> Rock Filled Yes ❑ No ❑ <br /> r Water Fable Depth .................... ............ ...........Rock Size •-----...---------------------•- <br /> ....Foundation ...... Prop. Line <br /> Distance toi nearest: Well .. ..............5 <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ........... ------------- ----------------- Date ................................... <br /> Septic Tank (Specify Requirements) -------•-------------------- ----•----------------•--.................•---- ---- ----- <br /> --- --------- <br /> Disposal <br /> - -- -Disposal Field (Specify Requirements) -.--------.��/1/ �1% .....-- d...... �-.----- - •------ i��C <br /> ----- ----- •. -----• -•------- <br /> I--- -- -- -------------------------- ... • • . . <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 /> CountyOrdinances, t ' <br /> r , Sate laws, and Rules and Regulations of the San Joaquin local .Health:District. Nome owner or liven- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for"which this permit is Issued, II shall not employ any person in such manner <br /> as to become subject to Workma Compensation l sof California." <br /> Signed ........ ----- - -- ---- --- -- •-- --• -•---------------- Owner <br /> By ----- ---...----- Title ..---- -- .......... <br /> {If other than owner} <br /> FOR DEPARTMENT USE ONLY <br /> — . �I-� <br /> APPLICATION ACCEPTED BY' - • - - ---- -- ----------------•-- -•�---_•-------------- --- :--- - - <br /> -- --- ------------- DATE ....... _G. 7' 7 --- -- <br /> BUILDING PERMIT ISSUED ---- --•--.... - ............::...• --..-------•------- ------ ------------ ......DATE .................. <br /> ADDITIONAL COMMENTS .._...__.._.................... .. <br /> f ............. ------------- -- -------------- - ------------------ -- ----------------------­- ------ ........._...------..._._..---...........-----..._ ................................ <br /> ------ .. <br /> Final Inspection by: ------------- --..-.. -------- ..---- Date <br /> EH 13 24 1-68 Rev SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />