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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> -- <br /> ------------------------------------------------ Permit No. <br /> (Complete in Triplicate) <br /> Date Issued <br /> ----,------____________________________________-______ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 5.49 and xisting Rules and Regulations: <br /> JOB ADDRESS/LOCATION .---- _ � --, ----i _ -_P --------------RATO -------CENSUS TRACT --- - �---- <br /> Owner's Name -_ l!!'1 ------ -- J -------------------------------�-----------f-------Phone ------------------------------------ <br /> Address J_7�_I0-- V --- - --------- -----:--------------- City /�✓� d�Y----------- -- ---------------------------`--- - <br /> �" s J License # r Phone bl " <br /> Contractor's Name ....�.- _- -f,- --- - - ----- - - ---�------------- <br /> Installation will serve: Residence (Apartment House❑ Commercial ❑Trailer Court i❑ <br /> I Motel ❑Other ------------------------------------------ f <br /> �`- <br /> Number of living units:____ ______ Number of bedrooms 3-_•___Garbage Grinder IVP----- Lot Size __1___ ---- -------------------------__Dai <br /> Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private <br /> Character of soil to a depth of 3.feet: Sand'® Silt F] Clay E] Peat E] Sandy Loam ❑ Clay"Loam ❑ <br /> I <br /> Hardpan ❑ Adobe ❑ ,Fill Material <br /> If yes,-type _______________- - <br /> (Plot plan, showing size of lot,Ilocation of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seep pit permitted if public sewer is available within 200 feet,) \ <br /> PACKAGE TREATMENT ( ] SEPTIC TANK[ Size_ ___� -x/�5 - -- ---- Liquid Depth ___I_---_---------- v <br /> Capacity _J_�CJ',__ Type - Material_4.: x?-C'APV Compartments-_-- _-Z.............. C, <br /> Distance to nearest: Well -------LT- __________________Foundation _�_ - __________ Prop. Line __-�__ ____-_-___ <br /> kLEACHING LINE ( No. of Lines ------------------------ Length Length of each line------—96-/--------- Total Length :_Ap�._________.-. a <br /> D' Box Type Filter Material _ � _,Depth Filter Material ______L << <br /> - /� ---------- <br /> Distance to nearest: Well --SO----�_ Foundation _/0_�______ Property Line. __J�___"�..... <br /> SEEPAGE PIT [ ] Depth t <br /> ------------------- Diameter ---------------- Number ----------- ----------------- Rock Filled Yes ❑ No ❑ <br /> WaterTable Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line .----------------_-- <br /> I <br /> REPAIR./ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------------------.--------------) <br /> SepticTank (Specify Requirements) ---------------------------------------------------------------------------------------------------------------.----------------------------- <br /> DisposalField (Specify RegUirements) -------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------- <br /> -=_. _ <br /> -------------------- ------------------------------------------------------------ ------ ----------------- ------------.-.--------_------------ --------------:---_------- ----_- -----_�_ - --_ <br /> (Draw existing and requirecl`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 /> County Ordinances, State Laws,i and Rules and Regulations of the San Joaquin Local Health 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 -------- --- ---- --- <br /> - --��--------------------- Owner <br /> -- �L <br /> ` � --------------------------------- Title ----------------------------- ----------------------------------- <br /> (if <br /> ------------------------------ - <br /> t (if other than owner) <br /> FOR .DEPARTMENT USE ONLY G <br /> APPLICATION ACCEPTED BY ------- -----. DATE -- <br /> ---------------------------------------- <br /> BUILDINGPERMIT ISSUED --------I--------------------------------------------------------------------------------------------------DATE -------------------------------------- <br /> ADDITIONALCOMMENTS ------- -- - ------------------- ---------------------------------------------------------- -- ------------------- ------------------------------------------- <br /> ---------------------------- ------ -- <br /> -------------------- <br /> ------------------ --- <br /> - ------------- - - = ------ ---- ------------------------------------------------------------------------------------------ <br /> ------- - -------- ---------------------------------------------------------- <br /> Final Inspect ---- - - -- -- --------------------------------------------------Date i <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M, <br />