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i <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ------------;r (Complete in Tri licate} <br /> ----------------------------- p P Permit No. = �� <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 /> TI* CENSUS TRACTJOB ADDRESS/LOCATION ----- ----- -------- <br /> Owner's <br /> Name: / Jf --- -----•-------------------------------- Phone- <br /> Address -- � -------- --------------------------------- { 4 _0 --------------------------------------- <br /> lev <br /> _ ' s� <br /> Contractor's Name ---- - "1- ►- �� -r ---------------------=----------License <br /> Installation will will serve: Residence ❑Apartment Housef] Commercial :❑Trailer Court "Cl r <br /> Motel_❑Other ------- -- --------------------- <br /> t <br /> Number of living units:... Number of be � <br /> droomsY----__Garbage Grinder &V- Lot Size-,S'�1` --------------- ! <br /> ip <br /> Water Supply: Public System and name --C -- 5,4,o---1 -Z,,r----------------------------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt]] Clay ❑ i Peat.E].._ Sandy-Loam-E]— Clay Loam.-B-1 <br /> a �.�� <br /> } Hardpan ❑ Adobe X Fill MateribR ----- If yes,type ----------.--_-_--___--__._ <br /> (Plot plan, showing size of lot, location of system in relation 14o wells, buildings tc. must�be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 20"eet,) <br /> r <br /> PACKAGE TREATMENT [ ] SEPTIC TANK:[ ] > _ <br /> Siie--__------ _______________ ----________--._--:- Liquid .Depth --------------------------- <br /> Capacity - Type _________-rP_---- --- Material---------------------- No. Compartments <br /> Distance to nearest—Well _- - -----------------Foundation ---------------------- Prop: Line ___ ---_-:__--_--. ` <br /> LEACHING LINE [ ] No. of Lines -- ---- Length of each line---------------------------- Total Length ------------------------------ <br /> 'D' <br /> ,-_------,-_-___--_-_-_-_- <br /> 'D' Box --__ ------- Type Filter Material --------------------Depth Filter,Material -------- --- --____?_________-__-_______._.._ <br /> t <br /> -Distance to nearest: Well __________________ __ Foundation ------------------------ Property Line;____.__-_--___.__._.... <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No.❑ <br /> Water Table Depth ----------------------------------------'-------Rock Size -------------------------------- <br /> 1 Distance to nearest: Well -------------------_------------ .......Foundation -------------------- Prop. Line --------- ............ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --------.------------------------------ R^_ Date y__---_---.:._.._-__--_---_--_-_..j <br /> Septic Tank (Specify Requirements) -------------------. _ -- --------------------------- f <br /> Disposal Field (Specify Requirements) ---47- --------�,.1"4---/,"--X--- 1 � j � ' <br /> ----------1�--------/a l >< �' �c-�r�y ---------------------- --------------------- ------------------------------------•-----------------=------- <br /> I <br /> -------------- -------------------`-------------------------------------------- ------------------------- ------------ --------------------------------------------------------- <br /> { (Draw existingand required addition on reverse side) <br /> I hereby certify that�I i>lave 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 Fiat employ any person in such manner <br /> .as to become subject to Workman's Compensation laws of California." <br /> Signed -------------- ---- - ----------------------- ------- - ---- ------ Owner <br /> -------------- <br /> BY ------------------ Title U�' � , rr; <br /> other than owner <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY �-. _ .----__ /� -----_� <br /> -- <br /> BUILDING PERMIT ISSUED ---------------- ----------- -------------------------------------------- ----------- DATE,- <br /> ADDITIONALCOMMENTS --------------------------------------'-------- ----------------------------- -----------------•------------- <br /> ---------- --------------------------------------------------------------------------------- -- ------------`-r-'--------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------- <br /> - / <br /> Final Inspection by =--- -- _ . =--------- - ----- -------------Date 6 ­72 <br /> � _ --------- <br /> AN`JOAQUIN' LOCAL HEALTH DISTRICT <br /> E --9' - 1=`68 Rev. 5M <br />