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r - ' <br /> r FOR OFFICE USi=: ` <br /> APPLICATION FOR SANITATION PERMIT <br /> ..... ........................... Permit No. ..") 3.'"9..y... <br /> (Complete in Triplicate) <br /> ...-- ------------------------•-------....................... <br /> .----_-.._---------------_----------_-. ... This Permit Expires 1 Year From Date Issued 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 /> '(� _- / _ at. 2'fO- 0&0O 27 <br /> ----------- <br /> JOB ADDRESS/LOCATION _.-.-... ......... .CENSUS TRACT .......................... <br /> Name ..--��/-C•h rL ._ .Il .El. .......... ......Phone ....-- ...... .......................... - <br /> Address -. c3 -- .. .�- rr�.rr�. 2 .�? . city L��.--. ...... _ <br /> Contractor's Name .. ��.. �7 . P /P__________________________________.License Phone <br /> Installation will serve: Residence •Apartment House❑ Commercial []Trailer Court ❑ <br /> Motel ❑Other ---------------------------------------•--- <br /> Number of living units: Number of bedrooms -.-.----Garbage Grinder ._...._.... Lot Size �?f�' ...... ------ <br /> Water Supply: Public System and name - ------------------------------------------ ---- . --------------------------------------------------------Private,( <br /> Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay ❑ Peat❑ Sandy Loam ❑ Clay loam ❑ <br /> Hardpan ❑ Adobe Fill Material ..... If yes,type .---- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) -4 <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK Size-__. <br /> ( ] � ] - Liquid Depth -f-�. ............. ' <br /> Capacity A:�d_.:.. Type I?�!e-Q-"'? Material..��-r� No. Compartments z........... <br /> Distance to nearest: Well .......6 _____________________Founddation _._.Z_0_ ----- Prop, Line t�__.__________-____ <br /> LEACHING LINE [ ] No. of Lines ........ ....... Length of each line......9a............ Total length _____-__ __._ <br /> 'D' Box .....r_.. Type Filter Material a __-Depth Filter Material /P_--------------____________________ <br /> Distance to nearest: Well _ 1 <br /> --� 7 <br /> ---.��-/--�---- Foundation .-- ��- - --- - - Property Line b---...--•----•-•----� A <br /> SEEPAGE PIT ( ! Depth -------------------- Diameter ................ Number .-----..------ ------------- Rock Filled Yes ❑ No [3 0 <br /> Water Table Depth ................................................Rock Size __.._.... .................... s <br /> Distance to nearest: Well ........................................Foundation ...... ..... ..... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................) <br /> SepticTank (Specify Requirements) -------- ------------------•-------------------------••••------;--------- ------•----------....... --------------------••------------ <br /> Disposal Field (Specify Requirements) ........................................_............-. <br /> •------•............... •-••--• . .... ----- --.._........•_• ..-•--------•-•L-•----- <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 licen- <br /> sed agents signature certifies the following: <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 become subject to Workman's ComPensatlon laws of California." <br /> Signed . ----•-- •-- Owner i <br /> By - ----------- -`.-...--• .......... .......................................... Title ` <br /> (If other than owner) <br /> c <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .... _----- --------•---•-----•--•--•-----.------•--•-._...-.__....-----•._....._....---_. DATE ---- .................................... <br /> BUILDINGPERMIT ISSUED........ _--------•--------- .......................................................................DATE ........................................... <br /> ADDITIONALCOMMENTS ----------- ......................................... • ---- .._.. - ............ ............... . ............................................._.._. <br /> -----•- ... --•----•--------------------------------------------------- <br /> ..............................-....................................... ................... ---------------- <br /> Final Inspection b -------------Date ..-�.. ..� .....-... . . <br /> SAN JOAQUIN LOCAL HEAT DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />