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VVIC OFFICE USE: f <br /> APPLICATION FOR SANITATION PERMIT - <br /> ........ -••...-.-..._.............. <br /> Permit No. .7S . . .. <br /> . .7�.. <br /> (Complete in Triplicate) .... <br /> ............. This Permit Expires t Year From Date Issued <br /> Date Issued ../.. --/77! <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 ma - ionce with County Ordinance No. 549 and existing Rules and Regulations: <br /> 93 62 <br /> JOB AI7DR155/lOCATI01 --......•--......---.�---• .Q� ..............CENSUS TRACT .............I............ <br /> - <br /> Owner's Name ... �----- /u -. . ........ one <br /> Address 6. . <br /> City 1.. . ./}IIJ/ 4C�4. ..... ----------- <br /> Contractor's Name .----•---••- -. rr' -,' .................................License ... ..a.-Z1... ... Phone .& j. 1 <br /> Installation will serve: Residence KApartment House Commercial❑Trailer Court 0 <br /> Motel ❑Other .----•-•--•--• •...............•••----••••- <br /> Number of living units:-_�._.. Number of bedrooms .....Garbage Grinder ............ Lot Size <br /> 7", �'r .. <br /> •.. .......... <br /> Water Supply: Public System and name ................ ....Private <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam C7 Clay Loam ❑ <br /> Hardpan ❑ Adobe 0 Fill 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 /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT { J SEPTIC TANK ........... ........................ .......... Liquid Depth ..........................,Q <br /> Capacity ----------------_-- Type -------.. _------- M Tial.............. ....... No. Compartments ......................f4 <br /> Distance to nearest: Well ...................... .............Foun tion ..--.................. Prop. Line ............I.........[� <br /> LEACHING LINE j j No. of Lines _.----------•----------- Length o each line.-- --------- Total Length .-----__.................. <br /> 'D' Box ............ Type Filter Mated ................... epth Filter Material ........................ ...................rn <br /> Distance to nearest: Well ........... ............ Foun ation ........................ Property Line ........................ . <br /> SEEPAGE PIT { J Depth -------------------- Diameter ............... mber -----------_--------_... Rock Filled Yes ❑ No i❑ <br /> G <br /> Water Table Depth ----------- -•---------------- --- -------------Rock Size .......... ..................... <br /> Distance to nearest: Well ---------------------- -------- ------Foundation .................... Prop. line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .. ........................._-.- -.---- Date ..........---..................... <br /> ) <br /> Septic Tank {Specify Requirements) ...-- <br /> Disposal F' Iced (Specify Requirements) .._ v./ -.--------/ --- ��- y <br /> ''- /fY- .. - <br /> ---------------------------- <br /> ---------------- ---------- <br /> -- <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 <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 a W man's Compensati laws of California." <br /> Signed _-.... --- -- o Owner <br /> BY Title---- --••---- <br /> (if other than owner <br /> DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY •-•-- .................. DATE . .. ��.: <br /> - ------ ------ ---- <br /> -- <br /> BUILDING PERMIT ISSUED ------------ -------------------------- .-•---------..DATE . .........................-_..:......... <br /> ADDITIONAL COMMENTS -------• --------------------- -- <br /> I-------. -•---- ------------------- ............... -- ---------- ------- --------- ----...-...----..-_.......... -- <br /> - 1.1­1 --------- <br /> Final Inspection by: ........... ----- ........Date-.. ...� <br /> EH 13 2h 1-68 ,Itev. SAN JOAQUIN LOCAL HEARTH DISTRICT 8/7h 3M <br />