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FOR-OFFICE USE; <br /> ------------------ --- - -- ------------------I--- APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Triplicate) <br /> ------------------------------- <br /> Date issued <br /> ----- ----- ---------- <br /> --------------------I This Permit Expires 1 Year From 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 hcation is made in compliance with County Ordinance No. 549 and existing Rules and Regulations! <br /> 1-0 7 <br /> a�_" 26 ------ <br /> JOB ADDRESS/LOCA? ----------------------------CENSUS TRACT <br /> Owner's Name _-T';1aK--------XV- <br /> -------XV-A 1"Ai 14 �------------------------------------------------------------------------Phone <br /> Address --------------------------- City ------------------------ --................ <br /> Contractor's Name _------------------ Phone <br /> �441_zo_ I-e------------------------------------------ <br /> License # ___ <br /> Installation will serve-. Residence Apartment House,E] Commercial :[]Trailer Court iD <br /> Motel F1 Other -------------------------------------------- <br /> Number of living units:- Number of'bedrooms--3-----Garbage Grinder Lot Size _-11v -41"--i- --------------- <br /> -/------- - 1, e 3 <br /> Water Supply: Public System and name ---------------------------------------------------------------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet; Sand� SiltF] Clay El Peat E] Sandy Loam -F] Clay Loam-1:1 <br /> Hardpan E] Adobe-E - Fill Material &0---- 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 /> NEW INSTALLAT]dN: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> Size_ f X 0 - <br /> PACKAGE TREATMENT SEPTIC TANK Ix �X_6-, Liquid Depth 5in <br /> ------ ------------------- --- ....... <br /> at, <br /> Capacity T__ <br /> ... Type 1114 <br /> T-2 _ aterial(?4 _414it No. Compartments __ � _._._.______ <br /> to nearest- Well ------- --------------- Foundation _/_64 Q� <br /> -- ---------- Prop. Line ---6----------------- <br /> . <br /> LEACHING LINE No. of Lines -_- --?------------- Length each line___,7.4__ ------------ Total Length ----------- 11-t <br /> 'D' Box ------------ Type Filter Material _Kv_A�----/L <br /> ----Depth Filter Material -----1-,V-*____-.____-----I._......_... <br /> Distance to nearest: Well ----67-a-1------- Foundation ............. Property Line __46-- -------------- <br /> SEEPAGE PIT Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 0 <br /> Water Table Depth ------------------------------------------------Rock Size ---------------------- ......... <br /> Distance to nearest. Well ----------------------------------------Foundation -------------------- Prop. Line ------------------- <br /> REPAIR/ADDITION(Prev, Sanitation Permit# ------_------- ---------------------------- Date ----------------------------------) F <br /> SepticTank (Specify Requirements) ----------------------------------------------------------------------------------------------------------------------------------------_- <br /> DisposalField (Specify Requirements) -------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------­----------- <br /> ------------------------------ ----------------------------------------------------------------------------------------------------------------------------- -------------------------------------- -- --- <br /> .(Draw existing and required addition on reverse side) <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son 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, I shall not employ any person in such manner. <br /> as to become subject to LWorman's Compensation laws of California." <br /> .... . . .. <br /> Signed ---- --------- --- ----- Owner <br /> By ---------- ----------- ------Z_ <br /> Title --------- ------- ------------------------------------------------------- <br /> ---------- --- ------- ------- ---------------------------------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------------------------------------------------------------------------------- DATE <br /> BUILDINGPERMIT ISSUED ----------------------------------------------------------------------------------------------------------DATE -------------------------------------------- <br /> ADDITIONAL <br /> -----------------------C--O---M---M---E--N--TS/ - -- ------------------------------------------ - -- --------------------- ---------------------- <br /> - ---- ----- <br /> --I------------------- ----------- - - - / <br /> ----------------------------------- ---- ---- -------- - -- - --------------- - ----- ---------------- --- <br /> - <br /> ------------- ---------------- -- ---- -- - -------- wZ <br /> Finalrinspec -Date <br /> --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />