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J <br /> FOR OFFICE USE:; APPLICATION FOR SANITATION PERMIT / <br /> -- - ------ --,•- ---------- - - Permit No. <br /> (Complete in Triplicate) <br /> Date Issued <br /> ------------ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made o tTie San Joaquin Local Health District for a per 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 _�_�_ _`�_-----5--------- ------------------a- fq_LO ---- --------CENSUS TRACT ----- ----------- <br /> - <br /> Owner's Name -• --------- <br /> Phone -------------- -------------------- <br /> Tf ®�s`l r <br /> Address __S_d��-- =----1�-�-�--- -��-- -------- - ----------------- ------------------• City -- - - --- - -- ------------•------ <br /> � <br /> �1 --------License #r $" 3 ~d---- Phone __Ak-a-- <br /> Contractors Name ------ <br /> Installation <br /> ---Installation will serve: Residence El-Apartment House❑ Commercial ❑Trailer Court ;❑ <br /> Motel ❑ Other ------------- ---------------------------- <br /> Number of living units:------ Number of bedrooms ___2-_-__Garbage Grinder E-i-P --- Lot Size ----_-__--------- -------------�------------ <br /> Water Supply: Public System and name ----------------------------------------------------------------- --------------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam;❑ <br /> Hardpan ❑ Adobe ❑ Fill Material If yes,type ____________________ ______ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be plated on reverse side.) <br /> NEW INSTALLATION:I (No septic tank'or seepage pit permitted if public sewer is vailable within 240 feet,) c/ A`► <br /> T SEPTIC TANK' Size --- -- - -- �-------------- Liquid Depth ---- -d-_---_------- <br /> PACKAGE TREATMENT [ ] <br /> Capacity ©-------.-- Type --- - -------------- Materia&!`f `l-r_ No. Compartments ----�------- <br /> istance to nearest: Well -- -/0D--------------------Foundation ---l0._-____- -- Prop. Line ____5_______________ <br /> LEACHING LINE No. of LinlIes -.___�------ Length of each line___. -----100--- Total Length ---�d�--------------- <br /> 'D' Box __[_.____._ Type Filter Material _--Depth Filter Material -------/7 <br /> ----A---------------- Property Line. S <br /> Distance to nearest: Well ___I_' -_______---_ Foundation • - <br /> ------------------ Diameter ------------------ <br /> -------------- Number .--------------- <br /> SEEPAGE PIT [ ] y Depth _______.--- Rock Filled Yes ❑ Na i❑ <br /> Water Table Depth y - Rack Size --------------------------- <br /> Distance to nearest: Well ---------------------- -Foundation~ ------------- ----- Prop. Line ---------------_---- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ---------------------------------- <br /> Septic Tank {Specify Requirements) -- ------------------------ -:.}----------- s �; ---`----;! --- ------------------------- <br /> --- <br /> Disposal Field (Specify Requirements) ----------------------- -------------- -- ---- _ -------- <br /> -------------------------------- ------------------- --------- ------- '--------------- -------------- --- ------------------- <br /> {Draw existing and required addition on reverse side) .r._ y _ <br /> I hereby certify that I have prepared this application and that the work will be done inY 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 /> ! "1 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 be a su ' ct to Work an's Campensati.on _California." �r' <br /> Signed --------------- - = rier <br /> k ~ ------------- Title -- ------- <br /> f <br /> f other than owner) <br /> FOR DEPAR ; ENT USE ONLY <br /> APPLICATION ACCEPTED BY ------ -- - -' ------------------- --------------------------- ----------------- DATE -----41 <br /> BUILDING PERMIT ISSUED ----------------- ------------- ---- <br /> - <br /> DATE' = F <br /> ADDITIONALCOMMENTS,--f - •- --- --- ----- ----- - -----== ------ --- ==------ --------•-•----=-- -------� =----- ---------­---------------- <br /> ­ <br /> ------- ---------------- <br /> ------------------------- <br /> ------------------- ------------- -- ------ ------ ---- --------------------- -------------------------------------------------------- <br /> ,��yy� - - ------ -------------------------------------------------- --------- <br /> Final Inspe =- -----Date - -------- <br /> Final - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> I <br /> I E. H. 9 T-'68 Rev. 5M <br />