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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> --------------59�- ----- Permit No. __.------------ <br /> (Complete ----- <br /> in Triplicate) <br /> --20 This Permit Expires 1 Year From Date Issued Date Issued <br /> 1 -2-'- 0 2_0- <br /> 2 <br /> Application is h6reby 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-------- --CENSUS TRACT -------------- --------_ <br /> Phone <br /> ------------------------------ -------- ---------------------------------_ <br /> ------------- <br /> Owner's Name --------- <br /> Address ---- _ __,0---------------------------------- ------------ City ----- ----------------------------------------- <br /> -------- ------------ <br /> ep <br /> Contractor's Name -------jl��t ---------S -.License # Phone --- 2--- <br /> Installation will serve: Residence []Apartment Ho6se-F <br /> ] Commercialgraileor Court <br /> Motel M Other ---------------------#---•-•­ ----------- <br /> Number of living units------------- Number of bedrooms ------------Garbage Grinder ------------ Lot Size ------- <br /> Water Supply: Public System and name ----------- -------------------------------------- -----------------------------------------------------------Private)<' <br /> Character of soil to a depth of 3 feet: Sancl'❑ Silt E] Clay E] Peat E] Sandy Loam -E] Clay Loam Ej <br /> -4 <br /> Hardpan Ej Adobe Fill Material ------------ If yes, type --__------_--------------- <br /> (Plot plan, showing size of lot, location of system in rel6tion to wells, buildings, etc. must be placed on reverse side.) <br /> or <br /> � I (A <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANKX Size- ------- Liquid Depth ------------- <br /> Capacity No. Compartments -----=---.............4 <br /> Type6��41 VMaterial <br /> Distance to nearest: Well - <br /> -,e:r <br /> 0---------- <br /> - t ----------------FoundZ----10�------ Prop. Line ..-,5----kmll <br /> LEACHING LINE No. of Lines ------/n---------------- Length of each line------�fation 140b---------------- Total Length ........... <br /> 'D' Box -- ---- Type Filter Material Depth Filter Material -_----,/ ---------------------------- <br /> Distance to nearest: Well ------- Foundation Property Line <br /> N a 0 <br /> --------- Number -----------4:;;�---------- Rock Filled Yes <br /> SEEPAGE PIT, Depth ---------- Diameter 61 A <br /> Water Table Depth ---------15-Z---------------------------Rock Size --------- <br /> Distance to nearest. Well /.tea------ ------------------FoundationProp. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------- Date ------------------- ---------- <br /> Septic Tank (Specify Requirements) --------- ---------------- --------------------------------- --------------------- ------------------------I--------------------------- <br /> Disposal Field {Specify Requirements) -------------------------------------------------------------------------------------------------------- ------------ --------------- <br /> ------------------------ <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 clone in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or liven- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance the work for which this permit is issued, I shall not employ any person' in such Manner <br /> as to be - su ject to,W"ma ' Compensati ws of California." <br /> Signed -- - --- ------------- -------11-_Awner <br /> By --------------------------------------------------- - i e '-`------------- ------ ------ <br /> ------- --------- <br /> ------ --- ------------ <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY 4 16-.. 011. <br /> APPLICATION ACCEPTED BYI-e.,1__ ---------------------------------------------- - ----. D-AfE ----------% ' <br /> BUILDING PERMIT ISSUED -------------------------------------------- ---------------------L----------------------------------------DATE __-N---------------------------------- <br /> — ------------ <br /> ............. <br /> ADDITIQNAL COMMENIS <br /> - ------- ---------------------------------------------------------------------------------------------------)----------------------------------------------------------------------------------- <br /> -------------------- --------------------------- --------------------------------------------------------- --------------- ----------I------- <br /> -- ------ --------- -----.-Date ----------- <br /> Final Inspection by- ---------------- --------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />