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APPLICATION FOR SANITATION PERMIT <br /> 1 (Complete in Triplicate) Permitb. No. .................... <br /> .... .-_................................... <br /> .._...... . .._...................................._ This Permit Expires 1 Year From Dofs Issued <br /> Date Issued r ....�7 <br /> LApplication 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/LOCFlTIOtJ ._..._l..Cz. $....._... Zl.•. ......I4,"";1............................... .... CENSUS TRACT .......................... <br /> Owner's Name .-.- . .�.�J.Erc .....: .�..::;. �:: i..............................._...............................................Phone ......... ....::::..,i............ <br /> Address ._...-./.- .k-......... .....A.-`:: .................................City -------''- 's. <br /> Contractor's Name ..... Cies <. cc. /. . ......................License # ........................ Phone ....:.......................... <br /> installation will serve, Residence Apartment House❑ Commercial ❑Troller Court 0 <br /> Motel ❑Other ...... .................. ................. <br /> Number of living units: ----/.----- Number of bedrooms .............Garbage Grinder ----- Lot Size .....1..,:;'>:............................ <br /> Water Supply: Public System and name ......................... -------------------------_......._..........................................Private (3, <br /> Character of soil too depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Cay Loam Q <br /> IFIINI <br /> Hardpan❑ Adobe ❑ FII( Material ............ If yes,type............... ............ <br /> C11- <br /> JPlot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.)IN <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer Is available within 200 feet,) <br /> PACKAGE TREATMENT I ] SEPTIC TANK[ Size......424-1:....... :<: -.---...- Liquid Depth ........... ........... <br /> Capacity -/ ^'.-. Typo LG1._.1.,1hSx4.s:. Material..._.;.>r.:: ._:.:: No. Compartments -_............... <br /> aZ <br /> C i . <br /> Distance to nearest: Well ... .r.......................Foundation ..-r.-:r::.- : <br /> ...---.-... Prop. Line :.:...-.......-:..... <br /> LEACHING LINE ( ] No. of Lines .-_...... ........ Length of each line_..-- ............... Total Length ............................ <br /> D' Bax _ z ...... Typo Filter Material .�............ ....Depth Filter Material .....::........ <br /> Distance to nearest: Well ..... .... Foundation .:.i ............... Property Line ...:.a:................ <br /> SEEPAGE PIT O Depth .-_._............. Diameter ................ Number ----- Rock Filled Yes ❑ No <br /> Water Table Depth --- --..........................................Rock Size -............................... <br /> Distance to nearest: Well .......................................Foundation .................... Prop. lino ........._...-..-.... <br /> REPAIR/ADDITiON(Prev. Sanitation Permit# ............................................ Date ..................................I <br /> _ Septic Tank (Specify Requirements) .......................................................... .............................................._............_................ <br /> Disposal Field (Specify Requirements] .......................... <br /> . ............_....................... ............ ............--•--- .............-----------•----...-.---...---..........-----................................--.......................... <br /> --......_... .................................................. ............................. .............................................................................. ...................... <br /> (Draw existing and required addition an reverse side) <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: <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 become subject to Workman's Compensation laws of California." <br /> Signed .... ..... ,...- Owner <br /> BY - ( � //tee /�✓ C . . . - ----------- - . . Title .-. <br /> ., (If other than owner) <br /> FOR DEPARTMENT USE NLY <br /> APPLICATION ACCEPTED BY --- . .. . ;/ v? ....... ........................................................ DATE .. ` �.".7�.-..... <br /> BUILDING PERMIT ISSUED . .......................................................................................-.-._..........DATE . .......... <br /> ADDITIONAL COMMENTS _ ._ _.........._........................--..........----..._..._....--........_... ---.......... ....__ .. ............. . .... . .............. <br /> -._ .--.-.. <br /> .............. ....._............ .. ........._....................................--. ......................................... ...... <br /> n. <br /> .._....___..---._....._-r...--------_........................-...........--.......__........_..._.. ........... -----................--.... ...................... <br /> . <br /> _.. ...... ... ... ... <br /> Final Inspection by: . - . ........ ...... I Dater ...... --- -. ----------.. .. <br /> ` T;TI 13 2h 1-68 ltev. % SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 3M <br />