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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ---------- Permit No. <br /> --- ------- ...................I "', <br /> �­.* i (Complete In Triplicate) <br /> ................ ------------ ---------------------- ..... <br /> 7 -Y <br /> - .7 <br /> .................. -------­------- it This.Permif Expires 1 Your From Date Issmid'.1. C Dote Issued I/V / <br /> Application is he'r'bby made to the Son Joaquin Local Health District for a permit <br /> mit to construct and install the work here <br /> in 1 <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations:.*,- <br /> JOB ADD kESS/LOCATION <br /> _ CENSUS TRACT -------------- <br /> peg <br /> -le <br /> ------- ............... . --Phone ....... <br /> Owners Name ......... <br /> Address ...... Ity . ................... <br /> el , <br /> ------------ el;;w—------_------------ <br /> _ -Contla or's ------------ <br /> 1 1 <br /> Installation will 'serve: Residence)koApartment House o' Yornrhercial OTrailer Court <br /> Motel' Other.......................... <br /> Number of livintr g-Onits._ bedrooms _-,#_....Gorbo%;ie Grinder .w MSIZ ................ ...... <br /> . ....... Number of bedr <br /> � <br /> Walpe ___�... .......................................... . ................... <br /> Water Supply. Public System and rfa 7 Private)< <br /> Charbcterof soil'f6a depth of 3 feet: SandT-] Silt Clay E] I Peat[j Sandy Loam F] f Clay Loom 0 <br /> I I -If yes, a ....�1 - <br /> ',Hardpan[3 Adobe Fill M6terial ------------ type ....... <br /> 'a IS0clings, etc. must be placed an 4-A on reverse side.) <br /> wr,(plot <br /> plan, shaving size of lot, location of system in relation to wells, <br /> wk- is!available within 00 16tj <br /> NEW:INSTALLATION: (No septic tank or seepage pit permitted if public-§e r.. 2 <br /> Liquid Depth ....t..................... <br /> PACKAGE TREATMENT SEPTIOTANK.1 Size_....... .................. ..... --------- <br /> ................. ments ._r............. <br /> Capacity ----------- •Type ......------------- Material ------ No. Comport <br /> T <br /> Distance to nearest: Well --------------_____-.-.__...._....Foundation'._._!............. Prop. Line.` ... !------ <br /> LEAC�IING LiNt No. of Lines ------- <br /> -1 ............ Length of each Total Length-.=_,_'.................. <br /> 'D" Box ....... --- Type Filter Material --------------------Depth Filter Material ------------------------------------------ <br /> Distance to n'earestLWell..____----- ......Foundation.................. ------..Prop" <br /> ................. <br /> SEEPAGE PIT Depth ----•-•--..._-_-•-•. _ ._Rock-RIIed__Yas_Q No (3- <br /> Water Table iDepth ..............Rock Size .......... ..................... <br /> LP1 <br /> Distance to nearest. Well ........................................Foundation .................... Prop. Line ......... <br /> f <br /> :Prev. Sanitation Permit# -------------------------------------------- Date ----------------------_--------1 <br /> --- ------------ ............... ....... .......... .................­­--------------------- <br /> Septic Tank (specify Requirements) --------------- <br /> �--- ------'j,�_ ...... .or <br /> DIS Sal Field-Specify Requirements) --- <br /> ------------------­_­­------­--- ....... <br /> --------------- <br /> ------------------------............................................................................................... <br /> --------------------------------------------------- <br /> ............ <br /> (Draw existing and required addition on reverse sid6. <br /> I hereby certify that I have prepared this application and that the work will be done,in accordance with San Joaquin <br /> County Ordinanc'es, State Laws, and Rules and Regulations of the Son Joaquin Local!'Health District. Home owner or licen- <br /> sed 4genti-signatuid terrifies the follaWin�:- <s <br /> "I certify that In'We performance of the work for which this permit Is issued, I shall net emplo'Y,any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> I gE:ine <br /> I I <br /> ------------ Owner <br /> By ------------- ------------ ------ <br /> 1 <br /> 6zi;;W ------------------------------------------ <br /> -- Tftie ... <br /> (ifther than owner) FOR DEPARTMENT USE ONLY <br /> �TFPLiCATION ACCEPTED11 .......... ....... ... DATE <br /> BUILDING PFRMIT'ISSUEO . .......... ------------- -------------- ---DATE .................................. <br /> ADDITADDITIONALCOMh1EN U Oct. 0 <br /> .......... ------------- <br /> -----------e.).Ar V <br /> ...........................................I------------------- ------------ .......... ------ .............. <br /> -------------- <br /> FinalZInspection ... ....... -1............................ ------------ -••...... ------••-•--.....Date _>_ ...... ....• ... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. . 1-'68 Rev. 5M <br />