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IFOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No- ---------- --- - <br /> -- ------------ (Complete in Triplicate) <br /> fir, <br /> ------------------- <br /> Date Issued " - ---- ---_---• <br /> ------------- <br /> . <br /> This Permit Expires 1 Year From ate slue <br /> ---------- <br /> ----------- <br /> -- <br /> --------- -- <br /> lth <br /> rict for a <br /> ermit to construct and <br /> q <br /> Application is hereby made to the San Joaquin LacaNiHle CaunDtytO Ordinance a No. 549 and existing Rules tand Regulations- <br /> PP application s made in compliance <br /> Regulations- <br /> described. This app <br /> JOB ADDRESS/LOCATION -- -- <br /> CENSUS TRACT <br /> - <br /> - .� Phone <br /> ( .. `�"------ ---- - -------------- -------------------- -------- <br /> Owner's Name Cit <br /> --------------- -- q <br /> Address ----------- � -------- = <br /> �- •• r � � 1-d"!"___ Phone-License # ---- ---:- - - <br /> Contractor's Name -.- - - ------ ------ O+ � <br /> Installation will serve: Residence M Apartment House,0 Commercial �Trailet Court ;� $ <br /> Motel ❑Other --- --------------------------------------- <br /> Garbage Grinder _. --------- of ize ---- --------------------------------------- <br /> its <br /> ------ ----- ----- - -- - - -- ,. . <br /> Number of living un ------------------------------------------Number of bedrooms .._._--"-"._ ---------Private M <br /> - --- ----------------- <br /> Public S stem and name .._.__.__------------------ Peat❑ Sandy Loam •l] <br /> Water Supply: Y Clay Loam ] <br /> Jr- Character of soil to a depth of 3 feet: Sand'[] Silt{] Clay <br /> I Hardpan,� <br /> Adobe [❑ Fill Material ------------ 1f yes, type ------ <br /> l3 <br /> 4� <br /> Plot Ian, showing size of lot, location of system in relation to wells, buildings, eaElable wmust ithin placed <br /> feet�on reverse' side. <br /> P <br /> NEW INSTALLATION (No septi!tank or seepage pit permitted if publjc sewer is qv <br /> •I' A ' x-'r_r_� Liquid Depth = <br /> PACKAGE TREATMENT { ] SEPTIC TANK![V Size_--°-- ----- �---------------- <br /> rdd - <br /> Capacity � ------ TYPe /&?41` `'' erial_ <br /> No.. Compartments <br /> 1. __S_0--------------------------Foundation ----/--------------- Prop. Line ---�7*------- <br /> I Distance ito nearest: Well ' <br /> i ---- Length of each line-4- - -------- Total Length - - - <br /> LEACHING LINE No. of Lines "_-fit <br /> 'D' Box <br /> yu-�_ Type Filter Material _. -,�/-,��--'Depth Filter Materia) '1?--- <br /> I Distance oto nearest: Well ------------------------ Foundation -------- <br /> ------------ <br /> Property Line. -------•-••------------- <br /> . J� Rock Filled Yes � No .tl0 <br /> Depth �i Diameter .3a�------- Number -------- ------------ c <br /> SEEPAGE PIT P --------. - <br /> Rock Size -02--------��� --------------- <br /> Water Table Depth ---- --b <br /> I � - �---- -- Prop. Line '�----------•------ <br /> '� `" z Distance.to nearest: Well .._��---------------------- Foundation _"-- <br /> I ------------------ ----- Date ----------------------------------� \� <br /> REPAIR/ADDITION(Prev. Sanitati�n Permit# ---- --------------------------------------------------------- <br /> M <br /> -------------•_ �l <br /> Septic Tank {Specify Requiremen s __ <br /> ------------------------- <br /> i Disposal Field (Specify Requirements) ---------------------------------- ------- =------- ----------------------------------------------- <br /> ------------ ----------- <br /> ------------------------------------------------------------------------------------ <br /> ------ ------------- <br /> ---- --------!---- --- - ----------------------------------------------------------------------- <br /> ----- i <br /> •� (Draw existing and required addition on reverse si e <br /> f 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> Count rdinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> I sed gen s signature certifies the following: <br /> I "1 ertenify that in•the pe or rince of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as t e o lett to krrr Compensation laws of California." <br /> Owner <br /> Signe } --- ----------------- <br /> -- -------------- ------------------------------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> � ---- -- - ------ ----- ----- ---- --- -- ------------ DATE ./�."�"...----------- <br /> ----- <br /> .G---------------------- <br /> APPLICATION <br /> ----- ------ --- <br /> APPLiCATION ACCEPTED BY --- -- - --- ----- - -- - -- ----------DAT ----------------------------------- <br /> BUILDING <br /> ----- ----- ------ ----- <br /> --------------------------------------------- ------ <br /> BUlLD1NG PERMIT ISSUED ------------ ----- -----------'----- ----- --•----- <br /> ADDITIONAL COMMENTS .. = <br /> - -------------------------------------- <br /> ..------------------------------------------------i-----.._...---------.._.. <br /> ._r-----------------------------------------------.._...__..__..__------.-_-._-.._..__..__._.._....._-.__-___-._.__..._� ..-.._.. <br /> --------------- <br /> ________________ -.._. .~_ _.O.-.._----- <br /> .__._-.___ <br /> -------- <br /> -- -�------"------- ----- ------ ------------------------------------------------ <br /> ------ ------ ---- ------ ----- ------ -----• ----- ----- -----Date -.�- <br /> . <br /> ,. Final Inspection by: ; <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />