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`70 <br /> JR QOTFICE USE. APPLICATION FOR SANITATION PERMIT <br /> '7,S -�F 2- <br /> -d— ...... <br /> .. .... . Permit No; .......... ........... <br /> (Complete In Triplicate) <br /> ............... .: .......... ......... ...... S <br /> !.t. Date Issued <br /> ..................... ........................r .......... This Permit Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit <br /> mit to construct and Install the work herein <br /> described. This application is mode in complianc 1 County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB 'ADDRESS/Lj)CfiLTION <br /> ....CENSUS TR&CT ............ <br /> ................... ........... 7. <br /> Owner's Name ... . . . . ... ---------PhoneF 7 <br /> 7... <br /> Address ................... ....... ..... ... ... .. . . . ......... ..... CI .. ........................ <br /> Contractor's Nomel -�-1 ...... ..... 11 se # ........................ Phone _---_.2 ...... <br /> Installation will serve: Residence[Apartment House]] Commercial OTroiler Court 0 <br /> Motel []Other --- ....................................... <br /> Number of living unitst.... ...... Number of bedroom .....Garbage Grinder ............. Lot Size ....................... ............... <br /> ► 461_��_ � <br /> S(Z. . 4& 'k <br /> WaterSupply. Public System and name ............ ....... ........................I.................. ......... .............................Privat <br /> A 1 1 4 <br /> Character of soil to a depth of 3 feet. Sand 0 SI I f Clay ❑ Peat Cj -- Sandy Loom 0 Clay LoomU <br /> Hardpan[3 Adobe fill Miate'rial ...... 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,,I <br /> pit permitted If public sewer is available within 200 feet;] <br /> PACKAGE TREATMENT SEPTIC TANK I Size.........................i...................... Liquid Depth ........................... <br /> Capacity ....... ------------ Type ......__.......... Material.................:----- No. Compartments ...... <br /> Distance to nearest. Well ........Foundation .........�L........... Prop. Line ................ j <br /> LEACHING LINE No. of Lines ............. .......... Length of each line............................. Total Length ............................:j, <br /> D' Box ............ Type Filter Material ....................Depth Filter Material ....................................4....... <br /> Distance to nearest: Well ........................ Foundation ...................... Property Line ........................ <br /> M <br /> SEEPAGE PIT Depth .................... Diameter ................ Number ............................. ❑Rock Filled Yes 1:1 No C] <br /> Water Table Depth.........................................._......Rock Size .......... ---_----- --------- <br /> Distance to nearest: Well ............. ...:-.Foundation .................... Prop.-Line ..................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .......... --................:...Date ....... . ..... <br /> Septic Tank (Specify Requirementsl ... ...... ................ .......................................................09 <br /> ......... ...... ........ ... . .... . ......... ....... <br /> ;------- --- <br /> Dis ;eq Preme <br /> Dis sal Field (Specify R ...4-e�?�- .. ................... w <br /> 4.......... --------- ---------- - ----- ----- ........... . . .. ... .......... ... .... .... . ........I.......t.................... <br /> .. ....... . . .......... .. <br /> ----------- ...........4------------------*.......................*..........­­............. <br /> Asting and required addition on reverse side) <br /> (Drawzxili�,�� <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Homo 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 becpmq subLect WAY4, dran's Compensat,Pm4aw� of California." <br /> S i g n e d E. P_ ......... <br /> Title I --------- .. .................. <br /> By ................................................... A ...... ........................ <br /> (if other than owner) <br /> KR DEPARTMENT U R, ONLY <br /> APPLICATION ACCEPTED BY _.,��:,� .. ..............................................DATE .......................• <br /> ItiBUILDING PERMIT ISSUED ........... ......DATE ......................... <br /> ........... .............. ................. <br /> ADDITIONAL COMMENTS .. .. . ........ .. .... .... <br /> ........... <br /> ... . ..... ...... . . .................................................. <br /> ........................ ......... . .. ........ ...... <br /> -----------------*.......*.............................................. .............. <br /> ----­------------------- - ------- --------------- -- ------------- <br /> . .......... . .................... ................................................................ <br /> ........................* ....... . ...... . ..... .......... ........ <br /> Final Inspection .. ..... . .... . ........ .. ..............................i......... ............. ........Date <br /> SAN OAQUIN LOCAL HEALTH DISTRICT <br />