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1 VR V( f 0--C VJC: _ <br /> APPLICATION FOR SANITATION PL.,OIT <br /> (Complete in Triplicate) Permit No. .7.7 -..-..._.. <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 ismadein compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .`7ff111.-11 -...I�.�r-C2 ,-- - <br /> 1``''. . ..._ ... ... ._.. ............CENSUS TRACT .....�.L. ................ <br /> Owner's Name ivl � 'c.........!' 1.. . Phone ...... <br /> /� n } .. <br /> Address 7 /�-U-C'Fi!1...._ City . .,�Q-t7 .. ... .. <br /> t .. <br /> Contractor's Name ............ ..<f. .................LIcense 416-�-�jC ..... Phone . 6..-...... . <br /> Installation will serve: Residence Apartment Housefl Commercial ❑Trailer Court 0 <br /> MotelE] Other . ...... .................................. <br /> Number of living units: . - -.-.-.- Number of bedrooms ....;�.....Garbage Grinder ............ Lot Size ....`x,/ .. ��.......... <br /> Water Supply: Public System and name ........................................................._....................................................Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam p Clay Loam <br /> Hardpan ❑ Adobe M' 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,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size........................................ Liquid Depth .......................... S <br /> Capacity -- ----- - ------- Type .................... Material...................... No. Compartments ...................... <br /> Distance to nearest: Well ....................................Foundation ...................... Prop. Line ...................... J <br /> LEACHING LINE [ ] No. of Lines length of each line ....... ............ ...... Total Length ............................ 00 <br /> 'D' Box ...... __ Type Filter Material ....................Depth Filter Material ............................................- <br /> Distance to nearest: Well ........................ Foundation ....._...... ...... . Property Line ........................ rJ <br /> SEEPAGE PIT O Depth .-_ .... ........ Diameter ............... Number ............................ Rock Filled Yes ❑ No C)(t <br /> Water Table Depth .... . ......................................Rock Size ................................ - <br /> Distance to nearest: Well .................................. Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit 1# .................. .......................... Date ...................................) <br /> Septic Tank (Specify Requirements) - ---------------• ---••---------------•........... <br /> -....... <br /> --.-............._.............. <br /> Disposal Field (Specify Requirements) .....................................:................ <br /> - ------ -- -- ---- - -- ---- .------•-•---------------------------._......_...---•••-•--.....-- ... ......_..........._...................................... <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, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed .... Owner <br /> By - - --- --..._ Title . .. _.... ............:. .....-. . .... <br /> (If oche han owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------ --------•--•------ = % '-' ,= +• <br /> DATE ... 77----------_-- ..,... <br /> BUILDING PERMIT ISSUED ............................................ ` -.... DATE . ........................................ <br /> ADDITIONALCOMMENTS ........ ............................................................... . ....-- ..•-•............................ <br /> _...._--- . ......... - - -- --------•----•-•----------•---_.....•-•-----...-_...-•---._...--•---•---- ......................... --- . ..-...... -- . •----------------------------...--- <br /> -- --------------- ------- ..................................................... ..................-........................... ----- ------.._....._......---- - ........................................ <br /> --------- ----------------------------------•-•-•----------..._...--•------••----------••----------•------------•------------..... <br /> Final Inspection b .........Date .._. -U'-_7-?._-._ __. <br /> EH 13 2L 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH b1STRICT 8/7h 3M <br /> CA <br />