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FOR OFFICE USE: ; <br /> APPLICATION FOR SANITATION PERMIT.�...:..... .......... Permit No. <br /> (Complete In Triplicates <br /> . r <br /> :....................................................... Date Issued 6- '`7`"7b <br /> This Permit Expires 1 Year from Date Issued ..... <br /> �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. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCAT N _..6 gDe.--.-/,� .'._._ A.---. -•..................... ...•..CENSUS TRACT <br /> OwnersName ..... . ..... .. . . ........�-�. .................................... .............-.....Phone ........ <br /> Address -.........•--.....�- .�� i,a-�' '._. .. City 1. ................... <br /> Contractor's Name C4__- � 't! -_----------------License ... Phone . ............... �._._: <br /> Installation will serve: Residence Apartment House Commercial OTrailer Court0 � <br /> Motel ❑Other....... ............................... <br /> Number of living units:------ Number of bedrooms _3._....Garbage Grinder ........a_ Lot Size ....-_........ <br /> .�1-t�e�_..._......� <br /> Water Supply: Public System and name ...............................................•........_................................. ............Privatev <br /> Character of soil to a depth of 3 feet: Sand 0 Silt Q Clay 0 Peat❑ Sandy Loam 0 Clay Loam <br /> � s <br /> Hardpan[] Adobe 0 Fill Material ............1f 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 pefmltted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ' �- SEPTIC LANK ize._.----.. <br /> (.]. _/� .................... Liquid Depth .. .. .._..... .� <br /> Capacity/ __... ..-- Type _A................ Materlal.'�:a3atf,�..... No. Comportments ......:......._.-----. <br /> 1 <br /> Distance to nearest: Well _._._. .__ _.: .................Foundation :...f.i..:.'`"...... Prop. Line .. ....:�........ <br /> LEACHING LINE (� No. of Lines -__..3............. Length of each line--------- 9............. Total Length ...../... ............. <br /> V Box .....1/... Type Filter Material . f .....Depth .Filter Material . e <br /> v - ----��-- c s <br /> Distance to nearest: Well -.-.---�---1.---_-- Foundation r__.. ...... Property Line ._�'....---•--......... { <br /> t <br /> SEEPAGE PIT Depth _.--•--- Diameter ` �r <br /> ..._ ..�,j-•-....- Number ---------- -------- Rock Filled Yes No (.3 <br /> Water Table Depth ...................................................t Kate Size <br /> Distance to nearest: Wellf ..............foundation <br /> f._.f...._.�_.r..,0_.Xs+. ....r./....�P.F.fr.o..p_ <br /> . Line ... f <br /> ...... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ................•-----------------•......... Date -----------...._.................. <br /> ) <br /> SepticTank (Specify Requirements) --- ---------------------•--------.......-•--•-•.......................--•---.--.-_-............-•---....................._. ----•--- <br /> Disposal Field (Specify Requirements) --------------••------ ........................___.............................................____----•-_--•---- -- ...... .. <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 accor4ance with San Joaquin <br /> County Ordinances, State Laws, and Rules and'Regulations of the San Joaquin Local Health,01strict. Home owner or licm <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 /> By - ------------ Title ------- ... --- ------------------- -------------- <br /> (If otkAd than owner) <br /> EOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------(f --- - ---.. .- ---------- DATE --�.. ''.. . <br /> ----------------------- <br /> BUILDING PERMIT ISSUED ------------------------ ---------••-- ........ DATE ._....----- ------•------- ................ <br /> ADDITIONALCOMMENTS ....---•-------•----..--.--•---•--------•-•--------•-••-•----•-•---------------------•----------•---------...._--. -----...-----------...............-•---•-- <br /> ----_/---------------•-•----- <br /> ------...... -•......................................•-•---- -- ............. ------- ------- -------------------------........................ --------- <br /> ----------•-------- ------- - --------------------------------------------------........................................ <br /> _.f d �� .. <br /> Final Inspection by: _.. --------�r " _.Date ...� ... .-----. .. �-..... --•---- <br /> 13 2h 1-68 deV• 5MSAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />