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FOR OFFICE USE, <br /> APPLICATION FOR SANITATION PERMIT <br /> ............ .................... ....... . . <br /> (Complete In Triplicate) Permit No. .7.....:......... <br /> ..............................I..-----•-•.......--------- <br /> This Permit Expires I Year From Date Issued Date Issued .................... <br /> Application Is hereby made to the San Joaquin Local Health District for a permit to construct and Instair the work herein <br /> described. This application is made 17 compliance with County Ordinance No. 549 an existing R�s�Regulations: <br /> �Y �j,t <br /> L¢r_ . ttt�!c ,t"'aey.A�. '.r I ...........CENSUS TitACT •...............� <br /> Owner's Name <br /> Phone <br /> Address ............... �. ...._ j •.............City ... .. ... ._._.... <br /> Contractor's Name _ -------- ----- ...... �v � .....License # Phone . 17�?0 7...: <br /> Installation will serve: Residence Q Apartment Hpuse q Commercial QTrailer Court Q <br /> Motel Q 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 0 Silt Q - Clay Q Peat Q Sandy Loam Q Clay Loam ❑ -� <br /> Hardpan Q 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 sldd " <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE: TREATMENT [ ] SEPTIC TANK xe._.�----�•�---------------'......... liquid Depth ...S.Y............ <br /> Capacityix.o Type -----••---.. ....... Ma#erial. .... No. Compartments ._.. -.......� <br /> r <br /> or <br /> Distance to nearest: Well ...Foundation ... Prop. Line ' <br /> LEACHING LINE [ No. of Lines -------I--------------- Length of each line--------V_1........... Total Length ..... l __•--.....__� <br /> 'D' Sox __.....--- Type Filter Material __ . .Depth .Filter Material ...... ........................� <br /> Distance 'to nearest: Welt'--------------- ------- Foundation -----10.7*;.. . <br /> property Line .. ... ....... <br /> t it <br /> SEEPAGE PIT,. [ Depth ...__ .----- Diameter -c _.-.... Number ----.___f..3 _........ Rock Filled Yes No C <br /> Water Fable Depth --_--------_--- ........................Rock Size _ tj�- -. -r ���".. i (S <br /> Distance to nearest: Well .................. ...f=oundation ... Prop. Line -- ............. <br /> REPAIR/ADDITION 1Prev. Sanitation Permit# ..........•------------------------......... Date ............................. <br /> Septic: Tank (Specify Requirements) <br /> Disposal Field (Specify Reg6irementsj .1.--------------------------------------- ............................................................................--.... . <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 HeaI&District. Hoene 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 Workman's Compensation laws of California." <br /> Signed ----------- ••---- --- -- -----C62& <br /> Owner <br /> -BY .... • .-. . ----- - '---.. ---- -------------------------- -Title ----- <br /> (if o er ownerl <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- .- ..r, <br /> BUILDING PERMIT ISSUED ................... __-DATE ........... ......... <br /> ADD#TIONAL COMMENTS ------ -..P �..a-1�e e._S.................. <br /> ..---• -- -------------------------------­ -------------•----- --------....----- .............................................. <br /> ---------- -------------------------------------------------------- ----------------------------------------- -------------- ..---........__...--•---....---....._....... <br /> ---_------------------------- - -- ------------•-------------•-- -----•-------••-- -------------- ........ <br /> FinalInspection by: ....... _ _.. ....... ................... --------.................................. ------. ............Date <br /> EH <br /> 13 '12h1-68 &v. SAN JOAQUIN LOCAL HEALTH DISTRICT 871 �31K <br />