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FOR OFFICE USE: 3 <br /> _4APPLICATION FOR SANITATION PERMIT <br /> :a`z)------------ - 9 <br /> (Complete in Triplicate) ------------ <br /> ----- <br /> r�. Permit No, -------------- ------ <br /> ---- ---------- Date Issued <br /> This Permit Expires 1 Year From 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/LOC TION .-' n 41CENSUS TRACT <br /> --- ----------- <br /> Owner's Name ____ - r'1 <br /> --- --- -- '. <br /> Phone-------------------- <br /> ------------------ <br /> Address _---------- --1 - ~'Cit <br /> _ -------------: <br /> - ------------ <br /> Contractor's Na `�`� --------------------- License # / �3 _ <br /> ��--- Phon t <br /> f t� Ir <br /> Installation will serve: Res idencej?�Apartment House❑,Commercial'❑Trailer,Courtef <br /> ❑ <br /> Motel ❑ Oth_e'r <br /> t <br /> � 4 C <br /> Number of living units:, ._--.__ N Imber of bedr� s�-____Garbage Grinder;_ -_-__{--_ Lot Size _____________X_�_ <br /> Water Supply: Public System and name -------- <br /> pp Y ' ❑ <br /> t t I -- - - - --- -t `-------------------------Private - <br /> Character of soil to a depth of 3 feet: Sand'❑] "Sil .� Clay ❑- Peat❑ Sandy Loam .E] Clay Loam ,[:] r <br /> {:Hardpan ❑ Adobe ❑ F!I! Material ------ -- if yes, type ----------------------- <br /> fPlot plan, showing size of lot, location of system;in relation,to wells, buildings, etc. must be placed on reverse side.] <br /> NEW.INSTALLATION: (No septicitank orseepage pi permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'[ ]~� Size -__ _._ Liquid .Depth -------------------------- \' <br /> ------------------------ <br /> t Capacity --------------------- Type ------ -;Material---------------------- No. Compartments N <br /> --- <br /> Distance to nearest: Wel! - <br /> -------------------------------Foundation ---------------------- Prop. Line ---- ----- <br /> LEACHING LINE " <br /> r[ ] No. of .Lines ----------------- Length, of each line--------------------- <br /> ------ Total Length <br /> 'D' Box ------------ Type:Filter Material --------------- <br /> ---_ Depth. Filter Material <br /> Distance to nearest: Well'_ <br /> ------------------------ Foundation Foundation -__-.-_------------ -- Property Line -------µ__ <br /> SEEPAGE PIT [ ]p Depth -------------------- Diameter ---•_---------- Number ------------_--------------- Rock Filled Yes ❑ No ❑ <br /> q. �. <br /> Water Table Depth --------------------------------------------------Rock Size <br /> Distance to.nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -----•-----____------ � <br /> t. P : • <br /> REPAIR/ADDITION(Prev. SanitationPermif5 --------_----------------------------------- <br /> Date <br /> Septic Tank_'(�pecify Requirements) ----:------------------------------------------- <br /> ---------------- ---------------------------- --------------------•----- - <br /> Disposal Field (Specify Requirements) --- �-- ---' <br /> .i <br /> lD <br /> F_ <br /> r---- - -- ---- <br /> -------- ----------------------------- <br /> --- ------------------ - <br /> t <br /> C <br /> ,._;. <br /> '(Draw existing and required addition on reverse si ] + <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: t <br /> "I certify that in the performance ofjthe w rk for whichg,, mit is issued,'I shall not employ an F <br /> as to beco a ect to W rkman's�Com satin P Y Y person'in such manner <br /> P ornia."Sign % <br /> ' -- Owner.By --- ----- ---------- -- <br /> --------------------------------------- <br /> - Title . <br /> flf other than owner) --------------------------- <br /> FOR DEPARTMENT USE ONLY. <br /> APPLICATION ACCEPTED 8Y ----- -- --._. <br /> ----------------------------------------- ----------------------------------- <br /> BUILDING PERMIT ISSUE DATE ------------- <br /> ADDITIONAL •--____- <br /> t <br /> COMMENT - _ <br /> - <br /> �° ��" - -�-�� --- - ---- --�- -- ------------- - -- =------=--- <br /> .� <br /> ---------------- ----------------------------------------------------------------------- <br /> -------------------------------------- ----------------- ----------------- --------------------Date is <br /> ------------- <br /> ------------------------------------- j <br /> ��'---- -_ . <br /> ----------------- ----- - -- ------------ <br /> Final inspection b - ----- ---- ---------- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT F ' <br /> E. H. 9 1-'68 Rev.'5M. =` <br /> _4 <br />