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i <br /> FOR OFFICE USE: —APPLICATION FOR SANITATION PERmif <br /> - -- -- ----------- <br /> (Complete in Triplicate) Permit No. <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 /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION _Aa `�f.lT . _._,. CENSUS TRACT ` <br /> > 4' ` <br /> p ,� r/ <br /> Owner's Name - - /-�+ --------------`--------------------Phone ------_--------------- <br /> > 1 a <br /> Address - '`--o-_;3..!�..__��.�r_.__.rr:�_-�. -- -`"-f------------------------•--. City --' ----------------------------------------------------- ------ <br /> Contractor's <br /> -- ---- - -- - - --- ----- --- -------------------- <br /> Contractor's Name ...... " =° -------------------------------------- -----------------------.License # ----------------------- Phone ----. ... ---------- ....... <br /> Installation will serve: Residence JJ4 Apartment House Commercial❑Trailer Court 0 <br /> Motel ❑ Other ----------------------. ------._..--------- <br /> Number of living units:-_�------- Number of bedrooms _ ------_Garbage Grinder ------- Lot Size _.......................................... <br /> Water Supply: Public System and name -------------------------------_- -------------------...........--------Private [� <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam <br /> Hardpan Adobe❑ Fill Material ---- ....... 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 pit permitted if public sewer is available within 200 feet,) LN <br /> PACKAGE TREATMENT [ I SEPTIC TANK DQ Size_S�_ ----- -------------------- Liquid Depth .�C-----.__....... <br /> y . <br /> Capacit _----_.-- TYPealk.---_ V. Material_ - 1 ._...... No. Compartments -------••------• <br /> Distance to nearest: Well ------- ---------------------------Foundation -14?-------------- Prop. Line <br /> LEACHING LINE No. of lines _�!7------------------ Length of each line-IR--------- ------------ Total Length .._1__-..®_i.._--_----. <br /> �Ir <br /> 'D' Box ---Y_ Type Filter Material '-.......Depth Filler Material _�_ .....__................_.-.... • <br /> Distance to nearest: Well ........................ Foundation _.---------------------- Property Line ------------ ----------- <br /> SEEPAGE PIT [X] Depth ----------- Diameter '.J�A........ Number -------- ------------ Rock Filled Yes ® No ❑ <br /> Water Table Depth ----f0------------ ....................Rock Size F-ar-r —_-----------.- <br /> r <br /> Distance To nearest: Well fM.......------------------------Foundation Z0,- .......... Prop. Line -�--.--._-.n- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _.------ ----------------------------------- Date ----------------------------------) <br /> Septic Tank (Specify Requirements) ------------------------------------------------------------------------------------------------.....................------_------ i <br /> Disposal Field (Specify Requirements) ------------------- ------ ------------------------ <br /> r <br /> -_.--------------------------- ----_----------------_--.------------------------------------------------_..--------------------- -------------------_-_-...._._.____-_.._.__..___._.-.__.._ <br /> (Draw existing and required addition on 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 subiect to Wo man's Co fiensation laws of California." <br /> �• <br /> Signed - w - ----------------------------- Owner <br /> lop <br /> ' By - - - - -----_- _ ------ -- - - - - ------------------- Title -------- ------------------ ---------------------- -------- <br /> (lf other than owner) / py <br /> FOR DEPARTMENT USE ONLY kY <br /> J <br /> APPLICATION ACCEPTED BY -- '�t�---------------------------------------- -----------------_ DATE �. 'fir.S - 7�.-----......-------- <br /> BUILDING PERMIT ISSUED ...----------------------------------------------------------------------------- -------- ---------DATE ----------------------------------------- <br /> ADDITIONALCOMMENTS -------- ------------ --- ------- ----------------------------------------------_--------------------'---------------------- <br /> y � ------ <br /> ----------------------------------------------------- <br /> ­--------------_ -- --------------------------- -------------------- --------- ---------------------------- -----,i-�-/--D- - <br /> - -----------------------by1 <br /> ---- -- ---- -------- ------------......Date ------- <br /> --•----------- <br /> -Final Inspection : , - — <br /> SAN <br /> JOAQUIN LOCAL HEALTH DISTRICT <br />