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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> (Complete In Triplicate) <br />.......... .............................................. <br /> Date Issued <br /> ............. this Permit Expires I Year front 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 com I' n:o with County Ordinance No. 549 and existing Rales and Regulations: <br /> JOB ADDRESS/, ............. .... .............. .... .........CENSUS TRACT <br /> LOCA ......... . .......... <br /> Phone <br /> ......... .......... ............... ...... . .. ..... <br /> ........ .... <br /> Owner's Nome <br /> .. ................. ................. <br /> ... ........ . ......... City <br /> Address ...........I .........14_* <br /> II - "- 44 Phone Contractor's Name ----------------- ..... .. .. . .............z........License ---- Pho ... <br /> i I <br /> Installation will serve: i Residence tkApartment House a Commercial'oTraller Court0,A. <br /> Et <br /> Moltel 0 Other -A-T77_----_--------- ........ <br /> I ................ <br /> Number of living units:--_---:i.... Number of bedrooms — _.._JGarbage Grinder ............ Si <br /> Xr <br /> Water Supply: Public System and name ..................... ...---.. ......6.......... Private <br /> i;1c <br /> 1- -- <br /> Character of soil to fe �—of Peet. S <br /> depth 0 Silt El 0peat o Sandy Loom 0 Clay Loam 0 <br /> Hardpan 0 Adobe fFIII 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.) <br /> _T I <br /> NEW INSTALLATION- (No septic tank or seepage pit permitted if public sewer is avall'o'ble within 200 feet,) <br /> .1 1 %el NJ I <br /> PACKAGE TREATMENT SEPTIC TANK I I Size........................ ....................... Liquid Depth .......................... <br /> ... No. ..................... <br /> ...... Type -------------- ..... Material...... ....... ... Compartments <br /> Capacity ------ I I I <br /> Distance to neatest: Well ....................................Foundation —................... Prop. Line ...._.._•___•-----_•-6 <br /> LEACHING LIN No. of Lines ........... Length of each line------ ...---...-•-••.••.._... 'total Length ............................ <br /> t I I I ..... <br /> D' Box. ............ [Type Filter.-Material� .......................Depth Filter Material ............. .......................... <br /> , <br /> �011tanck .............to nearest; Well -0. Foundation <br /> I ..................... PropertyLine .................... <br /> SEEPAGE PIT L Dept ............... ... Diameter ................ Number .... ...................... Rock Filled Yes 0 No <br /> rp <br /> Water Table Depth .......................... .....................Rock Size ............ ----_------------ <br /> Distance to nearest: Well ------- ................................founclatid-h---------- ......... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------.------------------------••-•---..... Date............­__....... ......Prop. Line ...................... <br /> ............... ...............I......... <br /> Septic Tank (Specify-Requir6ments) .. .. ...1—........ ...... <br /> Disposal Field (Specify Requirements): .... I -- -------6.,.s .... ..................... ............................ <br /> ---------------- ---------------------------- .......... ............................ ................................ <br /> -----------__............................... ............ ...................... ........r........ .............. ...... <br /> .......r..............................I----------------------- d addition on reverse side) <br /> I(Draw existing and require <br /> I hereby certify!that I hdvo,.prep W this application and that the work will be done In acc*rdanc* with San Joaquin <br /> , q, o wrier call- <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health:District. Mom 0 Of <br /> sed agents signature certifies the following: <br /> "I certify that in' the performance of the,work for which this permit is issued, I shall not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed - --------- -­----------------------- -------- Owner <br /> By ...... .. . ---- ­ -- <br /> --------•---- ------ <br /> -——-—-------- Title ------ ------------------------------------ <br /> (if oth an owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------------ ------------- DAT ------------------­ <br /> -----------------------------------------------1_------------ <br /> BUILDING PERMIT ISSUED ---------- .......DATE <br /> ------------ -- ........ ... --- - ----- <br /> _�V­ —.. ........ ..... ........ <br /> ----------------- <br /> ADDITIONAL COMMENTS .. ----'" ...................... <br /> - -- --------- ---------------- <br /> ---------------------------------- .......... ----- -- <br /> f. !X �, K"r <br /> -------------- ------------__------------------ ------------- ---------------------- ......... <br /> ----------------•--_-----------•-•-- ....... <br /> ------------------------­ ----- ------ --------- --- ----------- ------­--------- -------------------- ---------- <br /> ----- - - --------------- <br /> Final Inspection by: ------------ ----- -- -- ------ -------------------------------- ---------Date ......... <br /> EH 13 2h 1-68 ikv. 5M SAN JOAQUI LOCAL HEALTH DISTRICT 8/74 3M <br />