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FOR OFFICE USE: <br /> _ 'LICATION FOR SANITATION PERIv,, <br /> (Complete in Triplicate) Permit No. . ............... <br /> ... __ ... This Permit Expires ] 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 ....... ....... ':�C<.4:.7�:r -... _._ ___ CENSUS TRACT <br /> Owner's Name .e._.....-.....JG. sh � f "L ...................................................:..._. C> <br /> �=.z, <br /> .....:.rP;hone ......... . . ........-----------� <br /> Address .. . . City � -------------------------------------------- <br /> License <br /> - _............... <br /> License # Phone .............................. <br /> Ccntractor s Nam <br /> Installation will serve: Residence ❑ Apartment House•❑ Commercial ❑Trailer Court <br /> Motel ❑ Other <br /> Number of living units:. Number of bedrooms _--"--_Garbage Grinder ..-._... Lot Size ... -....... <br /> ... Water Supply: Public System and name ---------------..-------------------_ . - _........ --------Private Q� <br /> Character of soil to a depth of 3 feet: Sand T] 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 see age pit permitted if public sewer is available within 200 feet,) <br /> 1 <br /> PACKAGE TREATMENT SEPT . ....... Liquid Depth ... ....... <br /> - <br /> ............. <br /> Material--- _ <LNo. Compartments ........CapacityJ� Type ! <br /> Distance to nearest: Well .._.....1� ' .............Foundation .......IC - Prop. Line .�f ------------ <br /> _J <br /> G <br /> i <br /> / <br /> LEACHING LINE (�J No. of Lines _..J...._ ........ Length of each line lO f ---- Total Length _.�_D.Q.. ... ........ <br /> 'D' Box _.... ..... Type Filter Material ..... _f1'_..-.Depth Filte Material �r J <br /> Distance to n?re : Well ...... ?C' f�... Foundation _,.1.� .. ......._. Property Line ... ._. <br /> ........... m <br /> SEEPAGE PIT Z� Depth '� ❑ <br /> ( p S Diameter ___. .� .. Number r�..... ................ Rock Filled Yes NoWater Table .._.------- -- ----- ---- ---------Rock Size <br /> c-- D <br /> Distance to nearest: Well ...... ... . ..............Foundation _..L?_. ... _..- Prop. Line ... J ............. <br /> REPAIR/ADDITION(Prey. Sanitation Permit# ......................... .................. Date ...._..._._............____..._._.) <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 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 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 Wo kman s Compensation laws of California. <br /> Signed )----- Owner <br /> i <br /> By - ..............On <br /> ow <br /> .-- - - - . Title ..- '1�-/L-L�.4� �tl7l...:........ <br /> (If other ner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .Z,/-- ...... DATE .:.�-......1..... ; <br /> BUILDINGPERMIT ISSUED ................................ ------ ------•----............................--••--......--•............DATE .......................................... <br /> ADDITIONALCOMMENTS .................................................................._............................................................... ....................._..... <br /> ... .. ............... ..••-•-----.......-----.....-----•----•---.....------••------.•......................._....------....-•-----•--...............-------•--.......•----...--•--............... <br /> . . .. ...... ........................................ .................._..-----•----...................----••--••-•---...........................................---;................................. <br /> .... -............. ....................... ::,._..:..._... ................... <br /> .. ....-- ' ---••---............._.............. ..........;5.•......6... . <br /> FinalInspection by: ..................:_-...c_. :..........................................................................Date.,,­­-..'.­-­.."­.................._.... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />