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G FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT � <br /> . ._....--'--....0)........, Permit No. - T�,�.---r/_ <br /> IComplete in Triplicate)• <br /> k --'- -----...... <br /> -__.. ._ This Permit Expires 1 Year From Date Issued 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 /> Pdescribed. This application is mad�11, with Aunty Ordinance 549 and existing Rules and Regulations: <br /> dJOB ADDRESS/LOCAT N - ../, ..fe " ._ ._....CENSUS TRACT ............. <br /> Owner's Name 1 , - - Phone " <br /> Address ...--- --'- ...- .1 City -_----------- ----_------ ----------------- <br /> -Contractor's Name .../�"y ` � -•----------.License # . /rl�.. Phone d. .�.... r <br /> tnstailation will serve: Residence partment House❑ Commercial "❑Trailer Court ❑ <br /> '( Motel ❑Other -----------•--•----------------------------- <br /> i <br /> rNumber of living units:------- Number of bedrooms „?-_._--Garbage Grinder - .. .--- Lot Size ./�-x& -------------- <br /> !Water Supply: Public System and name ----------------•-----------•----•---------- ----------- ._ ._..._-------•-- --------------------.-----------Private [}�� <br /> `Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Feat❑ Sandy Loom ❑ Clay Loam <br /> Hardpan ❑ Adobeill Material If yes, type -----------------:.-•---__-. <br /> (Plot plan, showing size of lot, location ofsystem in relation to wells, buildings, etc. must be placed on reverse side.) <br /> rNEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> tPACKAGE TREATMENT [ J SEPTIC TANK [ ize-.. ,e� —- Liquid Depth W. -I------------- U <br /> Capacity .J .... Type '?4d Materlcid -Z: No. Compartments .-_-. '�.. ... 6� <br /> Distance to nearest: Well ----lo:g--._._-..-... . Prop.,Line <br /> t' Foundation -- p. 6 <br /> ~LEACHING LINE (Z?�No. of Lines -.. ---------- Length of each line--J-41-A ....... Total Length �.__-. <br /> 'D' Box%=ea <br /> _ Type Filter Material °�: ___...--Depth Filter Material ---�i7- Q <br /> cj'� <br /> Diston trest: Well f .. Foundation ... --d.---____------. Property Line .,�7� <br /> SEEPAGE PIT (�-; Depth i..- Diameter . 33........ Number -------- Rock Filled, Yes No i❑ <br /> Water Table Depth -----1_&-i----------------•--------------._Rock.Size . <br /> Distance to nearest: Well ....I/ - -------------------Foundation ------ Prop. Line _ !� <br /> f-ItEPAIR/ADDITION(Prev. Sanitation Permit e# -------------------------------------------- Date --•---------....------- ---------- <br /> J Septic Tank {Specify Requirements) ... --------------- <br /> C� Disposal Field (Specify Requirements) ---------------__----------------------------------.-------------------------------- ------- ------------------------------------- <br /> k ------------------•-----------I-------------------•---- ----------------------------•----------------••-----------------------------------..,.----------•------------ <br /> - ------ --- ------ ----------------------------------------------- -----------------------------................-...---•------------------------------------..-..... <br /> (Draw existing and required addition on reverse side) <br /> 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: <br /> ( <br /> F'l certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> is to become subject to Workman's Compensation laws of California." <br /> Signed ------------ -----------------•- .I,-..� Owner <br /> � ------- Title <br /> {1 o er than owner) <br /> FOR DEPARTMENT USE ONLY <br /> �%PPLICATION ACCEPTED BY ... <br /> I ---- ------------- ---- - DATE . 1 <br /> —BUILDING PERMIT ISSUED ...... --------------------------- <br /> -- - ...... DATE ................................. <br /> ---........ . .. <br /> ADDITIONAL COMMENTS ....-.:. - <br /> - ----------------------------------------------------------------------------------------------------------- <br /> ----- <br /> .-.­------------------------- <br /> --------------------------------- <br /> -------•-•--... ------•-- -- -------------- ------•-------•------------------------------------- .......................... - ---- ------------- <br /> f - i -3.. . .r� <br /> f.�:a <br />