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' FOR OFFICE USE: <br /> APPLICATION--LFO_R SANITATION PERMIT <br /> �� Permit No: --7�` -���_. <br /> r 3C.' ' 'Comple n Triplicate) <br /> ----------------------------------------------- G <br /> .___.__________________________________________ this Permit Expires 1 Year From Date Issued <br /> 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 /> JOB ADDRESS/LOCATION ._�-1_`�___ __________________CENSUS TRACT -------------- ----------- <br /> Owner's Name -------_ � ------- ---------------------- Phone 4aa_73s----- <br /> ------------- <br /> ---- <br /> � -_ _/-,;7- <br /> -- . ----- --------Address -- --------------- City J'_ - -- -- ------ <br /> Contractor's Name --- - -------------- -` �lrll-- -----------------------License #�--��fl(�-- Phone <br /> Installation will serve: Residence Apartment House❑ Commercial:❑Trailer Court <br /> Motel ❑ Other -------------------------------------------- <br /> Number of living 'units:/ --------_ Number of bedrooms _____Garbage Grinder ----------.- Lot Size _________________________________-___ <br /> WaterSupply: Public System and �ame ------------------------------------------------------------------------------------------------------------_Private V <br />' Character of soil to a depth of 3 feet: Sand?;;:;I-. Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> iHardpan ❑ Adobe❑ Fill Material ----- If yes,type _.____._________________ O <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.)' <br /> NEW INSTALLATION: [No septic+tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK i[ ] Size--------- liquid Depth 117 ----------- <br /> M " <br /> Capacity ��p- _ T /�aCy�✓ aterial_�C%xz tlo. Compartments ............. <br /> YP `����,�� / <br /> Distance 'to nearest: Well ------p?_l9_____ ------------Foundation ..-6-___________ Prop. Line ___:________ <br /> LEACHING LINENo. of Lines <br /> C 1 ---0- Length of each fine-----7------------------- Total Lengthr�f -----------.-.-- <br /> 'D' Box JL_____ Type Filter Material _1 - _______Z-�7epth Filter Material ____/-�________________ <br /> l t / ]---------- <br /> Distance to nearest: Well ___� _-__._____- Foundation ___�-d___________ Property Line ':?____________________ <br /> SEEPAGE PIT [ ] Depth __.g __._._._______ Diameter ________________ Number --------- --------------- Rock Filled Yes ❑ No <br /> Water. Ta le Depth --------------------------------------- --------Rock Size -------------------------------- <br /> Distance to+ nearest: Well ----------------------------------------Foundation ------_---- ------- Prop. Line ---.--- ......... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _-.------.---------------------------------- Date ---------------------------------- <br /> Septic <br /> - ____._-_______._____________Septic Tank {Specify Requirements) --------------------------------------------------------------------------------------------------------------- ---------------------- -- <br /> DisposalField (Specify Requirements) ----------- ------------------------ -------------------------------------------------------------------------------- --------------- <br /> - <br /> ----------------- ------------------------------------------ - ­ <br /> ----- -- -----­---- <br /> 1 <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 done in accordance with San Joaquin II <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, I shall not employ any person in such manner <br /> as to become subject to_Workma 's Compensation laws of California." <br /> Signed `- - ------ ----------- Owner <br /> -- <br /> BY Title <br /> {lf other than owner). <br /> !2R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------ ----- 'd''��~r``---------------------------------------------- DATE ........ <br /> --- "' f1 --------- <br /> BUILDINGPERMIT ISSUED ------------ --------------------------------------------------------------------------------------------DATE ------------------------------------------ <br /> ADDITIONAL COMMENTS ----------_ !_______ <br /> ---------------------"-------- ---------------------- <br /> ---------------------------------------------- - - - ---------------------------------------------- <br /> ------------------------------------- <br /> Final Inspection by: __Date . _._ <br /> 4 SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />