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t <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No: ...!�_�`..1 <br /> --- "-.'........... -. ' (Complete in Triplicate) i <br /> - -- � <br /> -.- -- ------ -------- - -- Date Issued <br /> --- - ----- -- `` <br /> .------„ This Permit Expires 1 Year From Oafs Issued <br /> 0os_!8a--sem <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?, de in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> C2 SzN- frlt ru/14T� ..YY .. <br /> JOB A6DRE55/LOCATION ._..-. '. .Y----yY.-'""a,..... f f r�^<-Iz.�C_ -�y�+ft-.---CENSUS TRACT ...-----.------- ` <br /> Owner's Name .._��L-e--.�',°rs�----�-�v..rt�'C----------------•---------------------------------- <br /> --/--",.---------...Phone ----.-...----.----'-------------• <br /> I <br /> Address ... L--Q......�r `��'rt'Y+�1 -�/�....................................City ------{Y# - ................... .................... <br /> Contractor's Name -. ..-�"-- r-- -- -----License# .. ------- Phone ------- <br /> Installation will serve: Residence [I Apartment House❑ Commerciall0railer Court C] <br /> Motel ❑Other . -....... ------•-------------------- <br /> Number of living units:............ Number of bedrooms ............Garbage Grinder ............ Lot Size ........................................... s <br /> Water Supply: Public System and name .----------........... .......... --..._--------- .........................-.................-----Private ❑ <br /> 1 Character of soil to a depth of 3 feet: Sand j] Silt❑ Clay ❑ Peat❑ Sgndy Loam❑ Ctay Loam[j '; <br /> Hardpan❑ Adobe'❑ Fill Material ---------- If yes,type ---------,------------------ W <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,) <br /> PACKAGE TREATMENT [ ] SEPTICTANKAJ Size-----'�_t....l..f..!�.--................. Liquid Depth _ .................... <br /> Capacity JPS T .--- Material.Cvw--. No. Compartments ...........:.... <br /> Distance to nearest: Well __.�--.t.__._-__._-------Foundation .1.4...--..__-- Prop. Line .._t)----............ <br /> LEACHING LINE [43 No. of Lines 1 . Length of each line...... --- Total Length ,_h................. <br /> 'D' Box ---�!------ Type Filter Material .eQ.'/1.-_......Depth Filter Material ........•-.--------••-----•••-- `^ <br /> Distance to nearest: Well ..._ .................. Foundatior{ ........................ Property Line .. ...... ..... �s^l <br /> SEEPAGE PIT [ j Depth ---:............ Diameter ............... Number ......................... .. Rock Filled Yes ❑ No W <br /> Water Table Depth --- - ------- ---------------Rock Size ---------- — ------.._......_ <br /> Distance to nearest: Well ----------------------------------------Foundation _........._...-..... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit#------------------------------------- ---- Date ----------------------------. --•1 <br /> Septic Tank (Specify Requirements) ----------------. ....... ..__._....._.-...... ....... ..........--•------------------------.._._:,.........-------------- <br /> Disposai 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 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 /> "1 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 sybbLoct to Workma 's Compensation laws of California." <br /> Signed ..... --....-_. Owner <br /> By - --- ----­............................................................... Title ................--.-...... -....._. .-.....---` - <br /> (If other than owner) <br /> -FOR DEPARTMENT USE ONLY <br /> " D i <br /> APPLICATION ACCEPTED 8Y _-,�`l.;c?es^'r_- d---....-------.-......-.---------...--.-------------.--.--. DATE .6.ya.._v�:...............-..---- <br /> BUILDINGPERMIT ISSUED -------- ------I-------- -----------------...................................'..............DATE <br /> ADDITIONALCOMMENTS -------------------------------------------..­­--- -------•-----. ---------------------------- ----- -------------------------- <br /> i -- - ..................................... ----------•....---- ... .. -- . ---------...... .._. ..... - <br /> -- <br /> Final Inspection b . . `/-�! ,r-en.r. - - ....... .............Date�". 1�x.Q-..... . _- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 ]-*68 Rev. 5M _ J <br />