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FOR OFFICE USE: <br /> APPLICATION ICOR SANITATION PERMff <br /> ..:.................................:--............. <br /> _....- <br /> _ IContplelein Triplicate) _ 4 ._. •.,Permit <br /> .. No� <br /> :................................::.......... ......... r <br /> ' `� Date Issued <br /> ...........:....................•___..._...-_............ . Thls Permlfxpires 1 Year From 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 .e a.._. __..._ --: _� __ __k...._... � <br /> . _ _ ............................CENSUS TRACT .....___-_:.______________ <br /> `� r <br /> Owner's Name AMR-AffRiV------ ....- � .. ... �� . ......:...:.... ..Phone <br /> ... _ <br /> Address _... � `.......�r__. f.!� ..._.,�._ <br /> Contractor's Name ---•-•--------•-------•--•---........:........License # .........1......._... Phone -----�i------ <br /> ------------------ <br /> Installation will serve: Residence 0 Apartment House❑ Commercial❑Trailer Court ] I <br /> Motel ❑Other ......................... .................. F <br /> i <br /> Number of living units:_.._' ... Number of bedrooms I Garbage Grinder Lot Size ............� <br /> i <br /> Water Supply: Public System and name ...................-.....................................-_.......--.........----=-;--•-......................Private Qi <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay [] Peat❑ ' Sandy Loam 0 Cloy Loam ❑ <br /> Hardpan[] Adobe Fill Mateilal .....-......If yes,type ...:........... ............. <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed an reverse sidej- <br /> i <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer Is available within 200 feet,) 10 <br /> PACKAGE TREATMENT jSEPTIC' TANK � mSfized_. � Liquid Depth -_ <br /> ------Z------------- � <br /> ��_T Capacity -•-• Type Compartments <br /> - <br /> Distance to nearest: Well _.__ ...-:7................Foundation -. 4� ....... Prop. Line _.. ._....... <br /> 7... <br /> LEACHING LINE [ J No. of Lines /.................... Length of each-llne_.........7...... ...._. Total Length ----7•.f.._-_._______.____. <br /> 'D' Box ............ Type Filter Material' _...----------------Depth .Filter Material ............................................ <br /> Distance to nearest: Well ............_•...., .._ Foundation ........................ Property Line ................ <br /> SEEPAGE PIT [ j Depth --.___!------------- Diameter _.__.__._._ _.. Number ............................ Rock Filled Yes ❑ No (3 � <br /> Water Table Depth _.__... ---•-----•----•------•-•.............Rock Size ................................ <br /> Distance tonearest- Well .__._..........................._.......foundation ------ Prop. Line <br /> REPAIR/ADDITION IPrev. Sanitation Permit# . Date ) <br /> Septic Tank [Specify Requirements).............. <br /> Disposal Field (Specify Requirements) ------------ E --------- ......... ................................................ .. <br /> ----------------•--•---- -------------------------------- .........-.................................... <br /> I <br /> -------------------------------------•-- - -------- ---------------------------------------------•---- ---•-------------------••-•----••-----••-•---•---•-•-•-••..... ................. <br /> {Draw existing and required addition on reverse side) <br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, andRules and Regulations of the San Joaquin Local Health-District.-Home owner or licen- <br /> sed agents signature certifies the following: I <br /> "I certify that in the performance of the work for"which this permit is issued, 1 shall not employ any person in such manner <br /> as-to beco a subject to Wa�rkma ' ` ,o nsafidh laws of California." <br /> / <br /> Signed ._ . .- ... ----------•..- Owner <br /> By <br /> ---------------------------------- ------------------------- •.. ........ Title _...------ ---_....................................... <br /> (If other than owner) <br /> DEPARTME IJ F. ONLY <br /> APPLICATION ACCEPTED BY . --- - --------------------------------- ------------------------ DATE...... " '.. <br /> BUILDING PERMIT' ISSUED -_-------- .-- -• .......................................DATE -. •----------------- <br /> -------------------------- <br /> ADDITIONALCOMMENTS ---------- -----•---..__......----••---••-•---••-•--- --•-...-•--............. ................... ..................................------- <br /> ---------- <br /> S -----------------------•-.•._..............._......... -- _ <br /> Final Inspection by: i.!__ ---------------Dat6 _ --- <br /> EH 13 2h 1-6B Rev. 5M � SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />