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FOR OFFICE USE: <br /> APPLICATIONFOR SANITATION PERMIT <br /> ........................ <br /> (Complete in Triplicate) Permit No. .�5._�3�.. <br /> .............................. -- <br /> .5 <br /> .........................:--•-•............. � This Permit Expires 1 Year front Date Issued Dane 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 It Ordi <br /> unnance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATIQ �- - --- .r...:--•-•.. ....................... <br /> r... .............. CENSUS TRACT ...--•--...... ............ <br /> _ <br /> i' -� .. . _ � 4 .. _... <br /> Owner's Name ...._._.. ... _ •-------• _ Pone <br /> Address <br /> ............e .'.. ...... ... .....: .. .. ... ... . ........ icense.... ........••.. .. <br /> City _ . <br /> Contractor's Nome .'..'... ... .... .-- -- - L .:. one .l <br /> Installation will serve: Residence[ Apartment H fl Commercial❑Troller[oust <br /> Motel 0 Other ............................................. <br /> r Number of living units:-...1 ... 'Number of bedrooms ..:.....Garbage Grinder .........,.. Lot Slze ..........................:...............:. <br />' Water Supply: Public System and name ....Private 11 <br /> Character of soil to a depth of 3 feet: Sand Silt Clay Peat Sand Loom Clay loam <br /> p � ❑ Y D E� Y � Y <br />! Hardpan 0 Adobe L Fill Material ............If yes,type <br /> (Plot plan, showing size of 'lo#,•location of system In relation to wells, buildings, etc. must be placed on reverse side.y <br /> t NEW INSTALLATION: (No sepilc tank or seepage pit permitted If public sewer Is available within 200 feet,) <br /> PAWGE TREATMENT [ SEPTIC TANK( ] Size................................................ Liquid Depth .....................,..... <br /> ` Ca <br /> -------------.... -pac�tY t TYip .......... .. Mateial.................... No. Com artmeMs <br /> .............. <br /> # Distance.to nearest: Well ....................................Found do ............... Prop. Line . ............ <br /> LEACHING LINE J No. of lines ---...�.__.--...•---... Length of each Ilne..___--. Tula! Length . ..._.: ""� <br /> --i." <br /> r D' Box 1 Type .Filter Material ......Dept Filter Material ............ ............. ........ <br /> Distance to nearest: Well .........................Foundation __.... ............ Property Line*' <br /> SEEPAGE PIT [ Depth _ 1-DiameterNumber _.. ..� F�.. (tock Filled Yes'�No ❑ C <br /> ............. . . . <br /> F Slzef. ' -------- <br /> O. <br /> Water Fable peach .....:........•--.......---•-----------•-- <br /> ......Rock <br />� I <br /> Distance to nearest: Well ......................................:.Foundation ._. �_._......,. Prop. Line :.............:....... .p <br /> REPAIR/ADDITION(Prey. Sanitation Permit` --.•---------------------------------------- Ddtef ............................. <br /> Septic Tank (Specify Requirements). - <br /> Disposal Field (Specify Requirements) --•--• ---•---•••--•........................•............... ............................ <br /> .............. ------ <br /> ................... ..............---------------- ...� ... ---------- ----- -- -------•--• -•---•- <br /> (Draw existing and required addition on reverse side) . <br /> I hereby certify that.( 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 Son Joaquin Local Health,District. Harm owner or Ilce*, <br /> sed agents signature certifies the following: "` <br /> I "I certify that in the performance of the work for"which this permit Is issued, I shalt not employ any person In such manner <br />' as.to become subject Work an's Co an a�fiion laws of ali rnla. ' <br /> Signed -- Owner <br /> -- <br /> BY :.. -- <br /> -..a <br /> .... --•---------- Jitli ' ............ . <br /> (If other than owner) <br /> ORDEPART NT USE ONLY <br /> 4 _ <br /> APPLICATION ACCEPTED BY ---------- - ---- -- DATE .;.,...,..,..-....,.;.... . <br /> i <br /> BUILDING"PERMIT ISSUED ......--------------------------------------------------------- <br /> ... ------------------------ -----DATE ............................ <br /> ADDITIONAL COMMENTS -------------`------------------ <br /> t <br /> --------------- ............... ..---------_...-- ------ ---------- ------ <br /> ---- ---- --------- ----------------•----------------•--•--- . . ...---------....................................... <br /> .... -•-••-. F <br /> �. <br /> final Inspection by: _ •. ©ate .... '-'� <br /> . 3 2 -68 1fev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />