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FOR OFFICE USE: ' <br /> 1 ip APPLICATION FOR SANITATION PERMIT ,9� <br /> ......... ...................•-•• ---..... . .......-. Permit No. ../.......-..... <br /> {Complete in Triplicate) <br />....................... ......, <br /> Date Issued .7` �S` 7 t <br />..................•......... ..................... This Permit Expires 1 Year From Date Issued / <br /> , <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 /> JOB ADDRESS/LOCATION -------I :. -------i.............................CENSUS TRACT ...._..:............._.... <br /> Owner's Name ... one .... . _ ..'.....•.6 ........ <br /> . Ph �I�y z1 <br /> Address ...-. 2d- .....M$. tZt•JG... .TLD------------------------•- 'x City ...�.f.01 t! •ti q!I_.............,..._.,_.................. <br /> .... <br /> Contractor's Name .......:.. -----------------�' .. d rl ... License # . 5 -3 3 Phone ._ �.�.^. Q�, <br /> Installation will serve: ?Residence (Apartment House❑ Commercial ❑Trailer Court ❑,- - -� <br /> Motel ❑ Other ............................ ........... ` <br /> Number of living units:....f-_.. Number of bedrooms __--3.....Garbage Grinder ..------LF Lot Size ....! aG.:..... .....•.......... <br /> Water Supply Public System and name ......._------•------------------ --=-----•-- •---• = ................................!.......Private ❑ ; <br /> Character of soil;to a depth of,3.feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sdr"dy Loam ❑ Clay Loam <br /> (}] Hardpan CJ Adobe❑ Fill Material..`..-.-.._ if yes,type ---------_--_.-_-.-__..... <br /> (Plot plan, showing size olot, location of,lystem in relation -to wells, buildings, efc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic sree�cige pit permitted if public sewer is available within 200 feet,j <br /> PACKAGE TREATMENT [ I SEPTIC TAMC i ] Size.......i.`"..................................... Liquid Depth ......- ............. <br /> Ccipocity ----'i............ <br /> Type .................... Material...................... No. Compartments ............... <br /> ..........: • - 0 <br /> Distance to nearest: Well --------____....................Foundation ...................... Prop. Line _.... ................ + <br /> LEACHING UNE [ ] No. of Lines------------------------ Length of each line----------_-----------_.. Total length ...........•................ <br /> . <br /> 'D' Box ------ --.- Type Filter Material ....................Depth Filter Material .----------.------_---------.-_-:-----_.:..: <br /> Distance to nearest: Well ........................ Foundation ....... Property Line ........................ U <br /> SEEPAGE PIT [ X Depth ---.--------------------- Diameter ................ Number ................--........... Rock Filled Yes [] No I❑ <br /> Water Table IDepth .................••. Rack Size <br /> Distance to nearest: Well ................................. ....Foundation .... _--_------- Prop. Line ..................-� <br /> REPAIR DDITION(Prev. Sanitation Permit# ............................................ Date .................................. <br /> t <br /> ptic Tank (Specify Requirements) ------ Q_Z"kCAZ cAc •-- -' &wi r...............................................-•-••----_----•- <br /> Disposal Field (Specify Requirements) ------------------ -- --------L�-N�.--�--. .'-•---`�_qr"tP-.-..._-i._..:----- � 4 <br /> •----------------------••--•-••---•-- ........------------------------.....----•-----......._...........-----•-••-••---•--...._................ ...................................................... <br /> ....................................................-._..-----------------------------------------......................... f <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 San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, dome owner or licew + <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 /> i <br /> Sign d ........................ Owner <br /> BY _.._ . Title ZV7'.............------------- ----------------------------------- <br /> {If otheY than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ... .. ...�.... ... ...-----•.................................... ................•• DATE ...�.....�.�'�,? ........ <br /> BUILDING PERMIT ISSUED .............. :...... ................................................ DATE <br /> ADDITIONALCOMMENTS ....................:...................................................-..........----------•...................................•--1--•........................ <br /> . <br /> ------------ <br /> .......................................... ---....... .-- <br /> --...---..... .," .-.....------•---..,....---••------............ -•-••------•---....._.........__................... ..-.. <br /> r ... ........ <br /> Final Inspection by: .................I......I..... Date .-.....-.............. <br /> J' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> r. u 13 24 1_,An uo.. Kut 7/72 3 M <br />