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F;Q!t OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ................................................ (Citntplete fm Triplicate) Permit No. <br /> �. .......... �. . <br /> ............... ....................... .. •...... ... This Permit Expires T Year From Date Issued Date lssuec!5. 1d'.:..27� <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 Cmade In compliance with Cou ty Ordinance No. 549 and existing Rules and Regulatlonse j <br /> JOB ADDRESS/LOCATION �.E:1.. 7. . . :.. �r�J .........................CENSUS TRACT ......................... <br /> Owner's Name .f ,2 ...................... ... ............ Phone .................................... <br /> Address � .. •--- ............................................City . ............................... <br /> Contractor's Name .. .-t. <br /> License � a$1f.. Phone _ `. y ... <br /> I <br /> Installation will serves esidence Ej-,Apartment House❑ Commercial❑Traller Court ❑ <br /> Motel []Other............................................ <br /> Number of living units:-.-----_._ - Number of bedrooms......Garbage Grinder ............ Lot Size ........................................ <br /> Water Supply: Public System and name . '. ..................­__.---_..-........................" ...........Private ❑ \ <br /> Character of soil to a depth of 3 feet: Sand 10 Silt❑ Clay ❑ Peat❑ Sandy loam 0 Clay Loam ❑ <br /> _ Hardpan❑ Adobe❑ Fill Material ............ If yes,type ............ <br /> (Piot 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 Size. Liquid Depth <br /> Capacity/ /J <br /> . ........................................ .......................... <br /> pa ty� YPe - (�.r�- - - Material---•----•---.----••--- No. Compartments _. -�:.....,. I <br /> Distance to nearest: Well .......Foundation �A . Prop. Line ..................... <br /> LEACHING LINE [ ] No. of lines ........................ Length of each line............................ Total Length .......................... <br /> 'D' Box J........ Type Filter Material .. .. ......Depth Filter Material .:2e.'2...�............................. <br /> r <br /> Distance to nearest.. Well ........................ Foundation ........................ Property line ....................... <br /> SEEPAGE PIT [ Depth .................... Diameter ___._..____ .... Number ............................ Rock Filled Yes (] No Q <br /> Water Table Depth ...-•--•...............................•......_.Rock Size -.-------.......__............. I <br /> ' Distance to neareste Well ...... Prop. Line 1 <br /> ...............».--------•--•-•_.._.....Foundation ---.._..---•-• ---•--•-•-------•..... <br /> REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date ..._................... ) <br /> Septic Tank (Specify Requirements) ..................... .........• ---............ ..... . .... .... ..... .......................--. .............................. <br /> Disposal Field (Specify Requirements) .eJ _._ _.. ..... .x........................ ..............--......._....... <br /> ... -------- ---- --•............-....... --........ ...... ..... <br /> ............._......_..._................ . ... ...._.. ..... <br /> (Draw existing and required addition on reverse sl do - .................... i <br /> I hereby certify that I have prepared this application and that the work will be Clone 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 beco sub(ect to. ... .rk. ma 's Compensation laws of California." <br /> Signed .-- --. .�_. .......................................................... <br /> ....................................................................... <br /> By ...................•........... . ... ....._.. weer <br /> IN other than owner) <br /> OR DEPARTMENT. SE ONLYel <br /> { <br /> APPLICATION ACCEPTED BY . - .... DATE 3 !.........:..7........ <br /> .... .. ........................... ....... <br /> BUILDING PERMIT ISSUED ..................DATE .................:.......:................. <br /> ADDITIONALCOMMENTS ...................................................................................................................--......................................... <br /> .......................................... . ... ... ......-..................... -- .. ..._:.... .....- _............._--.--............._...... ....... .........................................--- I <br /> .... ...: ...... ......................... . .......... I <br /> Final Inspection b .-.....-.Date .............. <br /> EH 13 2a i-613 V. <br /> 5K AN JOAQUIN LOCAL HEALTH DISTRICT 8/7!t 3M <br /> t <br />