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fVR OFFICE VSE, <br /> APPLICATION FOR SANITATION PERMIT <br /> l.�. (co , Permit No. � <br /> .....------• m !olein Trl licate) <br /> " Date issued �l^ 7� <br /> This Penmlt Expies 1 Year From Data 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. 5A9 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATI <br /> �a.:��`-C�... ......�.�...9'.9.. ............... <br /> ........... <br /> .......CENSUS TRACT .......................... <br /> Owner's Name ....... .. ...�-�......� !rf•r:. .... ... ....... ........ .. .......... ..Phone .................................... <br /> f�ddress .........--- •... 5 ... ! / - .. City .d ......................................... <br /> ... . ... . <br /> LLff T. <br /> Contractor's Name �..:. .. ..........................:_.License # .P� f 3 ... Phone :......961....... <br /> installation will serve, Residence EV(Partment House❑Commercial❑Trailer Court ❑ <br /> Motel ❑Other <br /> Number of living unitsi..., ._-- Number of bedrooms .�l. ......Garbage Grinder ............ lot Size/............................................ <br /> Water Supply, Public System and name <br /> Character of soil to a depth of 3 feet, Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ <br /> Hardpan❑ Adobe 0 Fill Material ............if yea,type ............... ............ <br /> !Piot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side. <br /> NEW INSTALLATION: lNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK f } Size................................................ Liquid Depth .._._...................... 1 <br /> Capacity .................... Type .................... Material...................... No. Compartments ...................... <br /> Distance to nearest, Well ................Foundation Prop. Line <br /> TEACHING LINE [ } No. of Lines ........................ Length of each line............................ Total Length ..........................' <br /> 'D' Box ............ Type Filter Material .....................Depth Filter Material .......................................... <br /> - f <br /> - . Distance to nearest, Well ..:..................... Foundation ........................ Property tine ................... <br /> SEEPAGE'PIT. [ } Depth Diameter ................ Number ............................ Rock Filled Yes [] No <br /> Water Table Depth ................................................Rock Size ................................ `„ <br /> A Distance to nearest, Well ........................................Foundation .................... Prop. Line .................... <br /> .. <br /> REPAIR/ADDITION(Prov. Sanitation Permit ............. Date ..................................) <br /> Septic Tank (Specify Requirements) ..--•.................._..._ ...................__.- -................... ...»....... ......,. ._.�...»,...... <br /> »................. <br /> Disposal Fiel ' (Specify Requirements) ._ .. Q.::�........................•---.....................I....................... <br /> .. . ...............•----........_..................---..............__..._............................... <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 accordance with San Joaquin <br /> County Ordinances, State taws, and Rules and Regulations of the San Joaquin tocol 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 be -su ect to orkmai _Com ensatlon laws of California." <br /> :Tonic' ......................................... ...•-- -•---....... ..--•-•----........----•. Owner�"','�� <br /> By . ............ fh r. ...ot... . .-own- ee ....... Title ....... <br /> (Ithan r) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ....(�'.... ....................... <br /> ....-... .................. DATE ......... <br /> BUILDING PERMIT ISSUED .....................................................DATE.:......................................... <br /> ADDITIONALCOMMENTS ......... .......' ................... ............................................................................................................ <br /> .. 4.. ................... ...................... ......-'-•--...................--......• .•• ' ..• <br /> ...._.... ..-•........... . .............. -.,......�.......--........ _ . <br /> ..........-. ....... <br /> ..... ............................ . �. ...... .. <br /> FinalInspection by. .. '-. -. .. -----..__........------._...........................:.................Date ..� .. <br /> EH 13 2h 1-68 Rev. jk_ SAN JOAQUIN tOCAL HEALTH DISTRICT 8/7h 3M <br />