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FOR OFFICE USE: <br /> . ...APPLICATION FOR SANITATION PIt,wAIT <br /> _ ................ ..�_........ _ _ Permit No. <br /> S O <br /> (Complete in Triplicate) <br /> ..._.-.....•__--_... This Permit Expires 1 Year From Date Issued Date Issued ... ._'/..d... .;� <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 ith County Ord' ante No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ../..gid.�f�J_....-, <a�-.-. -.�................................ ......CENSUS TRACT .......................... <br /> Owner's Name ..... .----N5�2 i'/ek'.5;•-•................••••--•--•••.............._......•--.•...`...............Phone .................................... <br /> Address --Ja_�w-� '. .................�............................._.._.... City 1/-lY.t--------.............................................. <br /> Contractor's Name .._.. ..��.. ���_=,1 'Q�� /.................................License #, ?.L, - -- Phone �`..� ..... <br /> Installation will serve: ResidenceX 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,® <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 publ.1 ic sewer I is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANKf�... ...... ...................... Liquid Depth <br /> Capacity/,W Type�t_ ... Material �r �.._.... No. Compartments .............. <br /> Distance to nearest: Well <br /> ..... <br /> ........................Foundation ;�!41 ......_... Prop. Line .... ........... � <br /> LEACHING LINE FiA YY No. of Lines -----7/'._...------ Length of each line_ll'�.�................ Total Length 4 U <br /> D' Bo �.J.._ Type Filter Material IG�tr+��.Depth Filter Material �..._`..................................... <br /> Distan a to nearest: Well ._..P��...__...... Foundation _2t ................ Property Line <br /> SEEPAGE PIT O Depth ..................._ Diameter ................ Number ..._.... ................... Rock Filled Yes ❑ No ❑� <br /> Water Table Depth ..Rock Size <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit,# ............................................ Date .............a.....................) <br /> SepticTank (Specify Requirements) .............................................---............•..----......--•--:..........................._..........-•-•--•---......_••--_ <br /> DisposalField (Specify Requirements) ...................•-..................--•--•--.......--•--...........--•--.....................---.............--•-•••--............. <br /> ------- ----------:------ ---••---.......................................---.....................••......-•---••--•----------•••-•-•-•-•........._----............. <br /> --- --•- --- --- . ._........... .........................................................-------•----•..__..._.................•---- . ........................................... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 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,mannw <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed -------------------A�thn <br /> OwnersJA <br /> By .. .. .__ ........... � ................................. Title 1�; .._................................. <br /> owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ....... <br /> - - •.. ... ........................................... ._. DATE ....2.:I.P- <br /> BUILDINGPERMIT ISSUED ............................ .. ...........................................................:.............DATE ........................................... <br /> ADDITIONALCOMMENTS .................................................................._...............................................................:.............._............ <br /> .............._--------------------............._........................................--.......-..-..-..--.---....................-----------•_....__.._._...........•......................_.......... <br /> '^ <br /> ...................................................................;...................................................................................................................................... <br /> --------- -----•---- -------- <br /> --- -- -• •• - - .. �Final Inspection by.. _ .Date � ....�.. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />