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� ,� <br /> FOR OFFICE USE,,_*-x� � <br /> 43 APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. <br /> ------------- ------------------------ ------- <br /> - <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-,-B Sc------ :------MV cf- __-_--7 -7 - <br /> - --CENSUS TRACT -------------------------- <br /> Owner's Name 'J! / " -- --- ------ ------- Phone <br /> Address ---------------- ---------- Ci#Y --� <br /> IVLContractor's Name _J1 -- -_ -- ( --- , ense # f �3 .�zPhone ------------------------------ <br /> Installation will serve: Reside e ❑Apartment House,0 Commercial:❑Trailer Court ❑ <br /> Motel E]-Other -------- r......----- ` <br /> Number of living units ------ Number of bedrooms ___________Garbage Grinder ----------._ Lot Size ------41------------------a---______- <br /> Water Supply: Public System and name --------- ----- ----- 1y^ "-''- Private <br /> Character of soil to a depth.of 3 feet: Sand' Silt 0____ <br /> Clay ❑- ^Peat❑L Sandy Loam.-C] Clay Loam ❑ <br /> Hardpan ❑ Adobe'❑ Fill Material ------------ If-yes,type - ------------------------ <br /> (PI'ot 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 public sewgr is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK'1 Size _-__ _ ____ <br /> �. <br /> [ � � � � �` 3--�-�---• -� --- ------- Liquid Depth --�-------------------• ��I <br /> �L�' Capacity4- Typ� ----- Material_- ----- No. Compartments ----�-----------= • ' ? <br /> [Nr t i <br /> Distance to necest: Well ------- _________________Foundation -------E_d `__: Prop. Line -----_________ <br /> LEACHING LINE No. of Lines]� <br /> { Length of each line------- bG'---�-- Total Length :---- .Q._.f_ <br /> .D. Box __ " - Type Filter Material ____S_)� Depth Filter Material _______f _________________________ <br /> Distance to nearest: Well ---- ___--____-__. Foundation ----- P__�_________ Property Line ------------------------ <br /> ! <br /> [ Depth ---�- - _ _--__ r�_-X�r �' <br /> ------ Number ------�-------i/---- ---- Rock Filled Yes ] No <br /> Fr <br /> Water Table Depth bra - ------ --------------Rock Size 'r �3--- ------ _U <br /> Distance to nearest: Well ---------1_-EJ-....................Foundation ....1-0 Prop. Line ---- --.....------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -----------------•----------------) <br /> Septic Tank (Specify Requirements) -----------------------------------------------------------------------------------•-------------------------- <br /> Disp',osal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- , <br /> ------------------------------------------------------------------------- -- -------------- - <br /> - - - - ------------------------------------------------------------------------ <br /> (Drawexisting and required addition-on reverse side) i <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, 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 '-------- ------------------------------------ Owner <br /> - - - <br /> - --------- _ Title ------- <br /> B {---------- (If other than owner) ---------------------- <br /> Y <br /> F <br /> F09 DEPARTMENT U-SE ONLY <br /> BUILDING <br /> APPLICATION ACCEPTED BY - ---- -------- -- ----- DATE .P'" y <br /> PERMITISSUED -==-------------------------------------------------------------------------------------------- --------DATE ----- ------- <br /> ADDITIONAL COMMENTS I <br /> ----- <br /> -------- ----------------------- ----------- -------------------------------------------------------------------------------------------------------------------------- -------------- <br /> - <br /> - - - - ----- -- ----- <br /> -- --- -- - - - <br /> Final Inspection by: <br /> ------- <br /> ---------------------------- ---------------------------------------Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. SM <br />