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f <br /> FOR OFFICE USE: " APPLICATION FOR SANITATION PERMIT <br /> -- ------ ----------------------------------- - <br /> (Complete in Triplicate) Permit No-.71:71-li�----- <br /> ---------------------------------------------------------- <br /> --------------------------------------------------- { This Permit Expires 1 Year From Date Issued Date Issued ,1_ 7�.. <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 5.49 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCA N ._- --- -- ` -- ---------h. <br /> �01` <br /> -------------------CENSUS TRACT __.-.--_�-.._ <br /> 1. <br /> Owner's Name � Phone ------------------------- <br /> v <br /> r <br /> Address f = - City <br /> ------------------------------------------------ -- <br /> Contractor's Name � ---- ----------------------------------------License #A57_?1Z9Z_ Phone __. .-. <br /> Installation will serve: Residence (Apartment House❑ Commercial :❑Trailer Court '❑ <br /> Motel ❑Other,-----------------------------= _ , <br /> Number of living units: -f Number of bedrooms, Garbage Grinders __ Lot Size ------- ------- <br /> Water <br /> ---•-Water Supply: Public System and name ---------------------- -------------"--------------------------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand'[:] Silt❑ Clay Q Peat ❑ Sandy Loam ❑ Clay'Loam.'F_1 <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 /> a <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,l <br /> PACKAGE TREATMENT { ] SEPTIC.TANK Sie_ _________________ Liquid `Depth ___._._..._.... <br /> Capacity /r Type _f es` Materiah_6"-4-r No. Compartments __-� <br /> Distance to nearest: Well ---s #y�---------------_----Foundation __------------ Prop. Line ...... Q <br /> -_______ _____ Length ouch lin __ -______ Total Length tv i <br /> LEACHING LINE No. of Lines ..___ <br /> 6r Wil .Com--------------- <br /> D' Box ?_ -z',Type Filter Matel��/��_ Depth Fitter Material flJ-- �I <br /> 01 <br /> Distance to nearest. Well ---------`--_ Foundation ` _______________ Property Line. ______._._____ <br /> SEEPAGE PIT Depth - _______ Diameter _______ Number ----- ------------------- Rock Filled Yes No .0 <br /> Water Table Depth ------ ----------------------------Rock Size__ - -------•--- <br /> Distance to nearest: Well __ /; _`__...............Foundation l ------- Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ----- ______________ ________________ Date ---___-____________-___-_____.____} <br /> SepticTank (Specify Requirements) -------------------------------------IN:---------------------------------------- ---------------------------------------------•----------- <br /> Disposal Field (Specify Requirements) -------------------------------1•:-----� --------------------------------------------------------------------------•---•----------- <br /> 1 e ,•L <br /> _________________________________________________________________ ____________r____-�e___�__._�_____________________________________________________________________________________________________ <br /> ten_ <br /> ----------------------------------------- _____j 7_�________________________-_-.----__-_--_--____.__.._-_____.___________________.___._-____- <br /> (Draw existing and required add.ition on reverse side) <br /> I hereby certify that I have prepared_ this application and that h work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local stealth 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 /> --/'e <br /> o er than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION .ACCEPTED BY -- _ - --� '° ---------------------------------- DATE S_'----- ' V------------------ <br /> BUILDING PERMIT ISSUED ----- - -- ------------------------------------ ----}---------{ ---------------------------------DATE --------------- --------------------------- <br /> ADDITIONALCOMMENTS ------------- - -- - -------------------------- ----------`----------------------------------------- --------------------- --------------------------- <br /> } <br /> T <br /> ------------------------------------- ---- --- ---------------------------------------- <br /> Final Inspection b ° �' ��'- _- <br /> p Y� ----- - - ✓-X��st.x.�------------------------------------------------------------------------Date .. ------------ - - --------------- <br /> �: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M. t � �` X\ ZS <br />