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' FOR-OFFICE USE: <br /> ..................._......................----........._ <br /> APPLICATION FOR SANITATION PERMIT Permit No. .T.7."��.' 7. <br /> (Complete in Triplicate) <br /> ............... ........•.........._..._..... ........ <br /> :.a ' 3 <br /> ................................................. This Permit Expires 1 Year From Date Issued Date issued ...... .. 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/LOCATION i /�`. • g!� I` .._ r... !•© -- s�r, -.....CENSUS TRACT ............. ... <br /> Owner's Name ............. .C?. A........:................. ------...._.._.-. <br /> ............... ....... <br /> Address .---- --IA!._.'r_..3......13. _A&...9D..--•----------• - City P .......................•--•--.. .................. <br /> Contractor's Name -----._.... •� ° 't`��5C4-•.t• ` ------------ --------License #-r. 5<.FS*3... Phone <br /> Installation will serve: Residence Ppartment House❑ Commercial ❑Trailer Court 0 <br /> Motel ❑Other ----------------------•---•--------------- <br /> Number of living units------- _._ Number of bedrooms .-3-----Garbage Grinder ............ Lot Size .../-1 ! .@ .............. \ <br /> Water Supply: Public System and name ......_..--'-----------•--- •........-•----•---•-•---••-•-....._._..........• ------------------------------Private <br /> Character of soil to a depth of i'Metr- Sand E] Silt❑ Clay 164-YPeat❑ Sandy Loam ❑ Clay Loam ❑ r <br /> )Hardpan ❑ Adobe❑ Fill Material --.--....... If yes,type ....................... - <br /> I (Plot plan, showing size .of lot, location ofsystem in relation to wells, buildings, etc. trust be placed on reverse side.) <br /> NEW INSTALLATION: (No'septic tank or seepage pit permitted if public sewer is available within 200 feet,) V <br /> PACKAGE TREATMENT j ]. SEPTIC TANK [ ] Size........ .�< �_ ,p Liquid Depth .�. ......-.- <br /> . - .-• <br /> Capacity ...�. X' Typei� Material.. c!t. No. Compartments <br /> Distance to -nearest: Weil _.. . .....................Foundation .... --------- Prop. Line .. .t.F....... _ <br /> F ® r <br /> ! LEACHING LINE [ ] No. of lines _.__--*: ....__: Length of each line------ 7.............: Total Length ���_......__._._. ro <br /> 10,'D' Box -_-3..... TyFilter-Material _ S.l�.�.....Depth Filter Material .�.�.n................`......._......_. <br /> Distance to nearest: Well ._._ ........... Foundation' -.... .............. Property Line .. ............ <br /> SEEPAGE PIT E ] Depth ._.._..... ter ................ Number ._._......_.......- ........ Rock Filled Yes ❑ No ❑ <br /> Water Table epth .: ......_..Rock Size <br /> Distance to nearest: Well..:.. ..................................Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ........ ............................... Date .................................. <br /> SepticTank (Specify Requirements) ...............................,------ ....................:......................•....................................•••--................. <br /> DisposalField (Specify Requirements) ........-.....................................................................................-...............,...................... <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 laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or lice"- <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 Work n's Compensation laws of California." <br /> Signed ........ -------------•--. . ----••............-•----... Owner <br /> R <br /> By ----• ........ t/1,�. ---=-••... Title` �:_• ............ <br /> (If other than owner) <br /> FOIt-.DEPA T O LY <br /> APPLICATION ACCEPTED BY .. :.. ........ DATE . .. . .................... <br /> BUILDING PERMIT ISSUED ...................... = - ..... -•----............... ----._ ...... ..................DATE . <br /> ADDITIONAL COMMENTS .-!•'' . ... <br /> -• ...----•-•-•-••....................................................................-•---------•--•••---_... .....I _...._............................................ <br /> :.:.............. ...................._..... .......... <br /> ....................... ................... •._........:.......................•----------------------..................-•---......... ..: . ---._....... . <br /> FinalInspection by: .....................................-----....---••---•---.................................. ..... . . ...Date .... + ................ <br /> SAN JOAQUIN LOCAL HEALTH I ICT <br /> Co <br /> E. m.13 24 1.'68 Rev. 5M 7/723-24 <br />