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FOR OFFICE USE: FOR OFFICE USE;: <br /> APPLICATION FOR SANITATION PERMIT <br /> --------------------- --------.....-_... - - - Permit No.... <br /> (Complete in Triplicate) <br /> -­---------------------- . . Date Issued �_�_�I`--7F <br /> This Permit Expires 1 Year From Date Issued <br /> h <br /> Application is hereby made to-the' San Joaquin Local Health District fora permit to construct and.install the work herein described. I <br /> This application is made in com fiance with County Ordinance No.'549 and existing Rules and Regulations: <br /> n., <br /> JOS ADDRESS/LOCATION. -_�---- . CENSUS TRACT <br /> ---.... <br /> Owner's Name... .. -- .-----Phone.---- :...... ................. <br /> ---� - . ne tea . -------------------- <br /> ... ra <br /> Address..... .��.�-.� ...._. t--�dy-'`1 ... Ci#y_._.`^ ZIP <br /> t -- lbs <br /> Contractor s Name.. { -- '?''1'".I-��hF--.` -� `.. License #' i�'"� �-�'. Phone_.. <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial)j `Trailer Court ❑ <br /> - <br /> Motel ❑ Other_.._._._. - ------------------------------ <br /> Number <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 j Silt❑ Clay ❑ Peat El Sandy Loam ❑ Clay Loam E] \13Hardpan E] 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 C ] Size------- __ --------Liquid Depth-------------------------- <br /> --------------Type--...------. <br /> Material------------ = <br /> -------------No. Compartments-----• --- ------.....--------- <br /> Capacity... - . --... = . <br /> Distance to nearest: Well----------------- ---------Foundation------ .. . ----.-.:..--.Prop. Line........-..........---...... <br /> ' LEACHING LINE [ ] No. of Lines -- _----------------------Length of each line.------------------- - --. Total Length . •---•--------- ----------- <br /> t = - D' Sox......_.... Type Filter Material------"-" ---..... Depth Filter Material------ ------------- ------- ----- ----- <br /> .6 <br /> .. Property Line---- ._.............. <br /> Distance-to neares#:Well_ _.____------ Foundation.-�----------------- - <br /> SEEPAGE PIT { ] Depth..:..... . ... .Diameter.-----------........Number---------------------------- Rock Filled Yes ❑ No❑ <br /> Y <br /> Water Table Depth------------------•-----------...... -=--- -----•--:- :Rock Size. <br /> - . <br /> i Distance to nearest: Well.-------------------- -----Foundation.-.------------ .....Prop. Line----------- --•---.. . <br /> REPAIR/ADDITION (Prev. Sanitation Permit#--------------- ---------- ----- ............Date---.----------- ----- -----) <br /> i <br /> Septic Tank [Specify Requirements).... ............ ..... -----/-� ------- ----- - -- .. ....._....----n--=----------------- --..._.----------------------- <br /> �__.�C- J - i .---------- ---------- <br /> Disposal Field (Specify Requirementsi....�� - -•`C......- . 1 ��� <br /> ------------------------ ---------- -------------------------------------- <br /> ....................... <br /> = <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certify that I have prepared this application and that the work will. be done in accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents <br /> signature certifies the following: <br /> "I certify tha ' the performance of the work for which this permit is issued, I shall not employ any person in such manner ols. <br /> to bec a ubject to Workman's Compensation laws of California. <br /> Signed --- -- .-_Owner <br /> Aned <br /> ....Title..�'e �1 <br /> thr than o <br /> i FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED <br /> ` ---- <br /> ADDIT NA COMMENT _ . _ DATE.- ....... ....... ---- <br /> ------------- ----•-- --...--- ------ ---------- - ------- --. . .. .. <br /> DIVISION OF LAND NUMBER. 4+l � --.. _�-...... <br /> .............. <br /> ------------ ----- - .:. . <br /> •-------•- -------------- ------------ <br /> ---- <br /> Date. <br /> Final Inspection by:.......... --------------- ---- - <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fas ara» 0.@v. ���et; <br />