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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. __7 z, <br /> ------ -- <br />. .- .- -------< --- --- --- -� '----- - -- {Complete in Triplicate} <br /> p Date Issued ... <br /> This Permit Expires ] Year From Date Issued <br /> lcation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> Appi <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> . CENSUS� TRACT -----_--------____________ <br /> JOB ADDRESS/LOCATION --- <br /> ------------------- <br /> ! <br /> Phone c <br /> Owner's Name ----- -.- !--- <br /> ' Y ------ -------•_. Y <br /> Address ----•------- --- - --- <br /> o 44F9--------------- --------------=--------License # ' Phone <br /> . �.--- <br /> Contractor's Name --��+�' --.-���` ------ - - <br /> Installation will serve: Residence �rtment House❑ Commercial :❑Trailer Court i❑ <br /> WOW ❑Other _.___._ • _ ' I�.. •, �� � <br /> Number of living units:_-- ----- Number of bedrooms ---1------Garbage Grinder _..__- --_ Lot Size - private ®� <br /> Water Supply: Public System and name ------- -------- ------------------------------------------ <br /> '---- ---- r <br /> Character ofI.soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑" -v Sandy Loam ❑ Clay Loam ❑ <br /> i V <br /> Hardpan ❑ Adobe ❑ Fill Material - '. __ if yes, type <br /> i. r. <br /> (Plot plan, showing size of lot, location of system in relation to wells, <br /> builAiings, etc. must be placed on reverse side.} 0 <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer,is available within 200 feet,) I# <br /> / <br /> Depthth -- <br /> -1/-Op--------------- <br /> TANK'[ ] -------------- - Liquid <br /> PACKAGE TREATMENT SEPTIC _ No. Compartments <br /> Capacity ----- Type -�ele----- Material------ t <br /> "..�" Foundation �p Prop. Line ----------- <br /> Distance to nearest: Well _--.- -=---y ---- t. / <br /> t ----------- <br /> LEACHING LINE [ ] No. of Lines .'"- <br /> ----------- Length of each line.---aV_419. fi- Total Length E-- _V--•----------- <br /> D' Sox Type Filter Material Depth Material ------Z�-------•--------�•---•-- <br /> Distance to nedresfi: Well -�---- -- -- Foundation; --,_f --- Property Line --- -------- <br /> i ,I ,g a <br /> Depth Number � - t Rock Filled Yes ❑ No <br /> SEEPAGE PIT L l p ---- ------- ----- Diameter --------- 0. � . <br /> Water Table Depth <br /> ---•---Rock Size ---------------------------------. <br /> • -----------------•- - " <br /> I Distance to nearest. Well ------------------------------------ Foundation _------------- ---- Prop., Line --------------------- <br /> 4 ------ ------�------] <br /> REPAIR/ADDITION(Prev..Sanitation Permit -------------------------------------------------- --------------------- DateE ------------- <br /> Septic Tank (Specify Requirements) __--------------------- --------- ----- <br /> - <br /> . --------------- <br /> Disposal Field (Specify Requirements) -------------------------- ---------------------- ----- ------- ;; <br /> ------------------- <br /> ------------------- --------------------------- ------- --- --------------------------------- --------------------------------------- <br /> ------------------------------ t <br /> -------- ---- ------------------------------------------------------------------------------------------------ <br /> ----------------------------------------------------------- <br /> (-Draw-existing- and required addition on reverselside} <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 L$cal.Health District. Home owner or licen- <br /> + sed agents signature certifies the followietg: <br /> ' "I certify that in the performance-of thework for which this permit is issued, k shall not employ any person in Such manner <br /> as to become subjec to .,aorkman's Compensation laws of California." <br /> Owner <br /> Signed <br /> te , <br /> { ". .. . <br /> -------------- <br /> a _ ---- --------- ----- Title ".-- ------------�;---- ------- -------------- <br /> By <br /> ------- ------------ <br /> If other than owne <br /> - - -- - - ---- - -- - - - <br /> e j r] <br /> r FOR DEPARTMENT USE "ONLY <br /> - <br /> . � - -- ------- --=----- --------- ----� DATE -�=�` -----•-- ------- ------- <br /> APPLICATION ACCEPTED 13Y + � �� - DATE -------------•----------------------------- <br /> BUILDING PERMIT ISSUED --------!j----------------------------- ------------------------------------ <br /> ADDITIONAL COMMENTS -----------------------�----•-- ------------------------- --------------------------------,,--- = <br /> -------------- ---------- -------- --------- <br /> f c = ... _ <br /> --------------------------------------------------------------- <br /> __________________'________.__---_----__--___.--___--j---____--___--_-_--____---__--_-.-___-.___-- ___.__---__.- ____-__.__ - ---------_--_---- <br /> I --------------------------------------------------- Date ------ <br /> -------------------- -�,h - <br /> Final Inspection by ----------------- <br /> SAN <br /> - -- -------------------------- --- ---- --- <br /> SAN JOAQUIN LOCAL HEALTH;DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />