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o <br /> FOR OFFICE USE: -i�y t. <br /> APPLICATION FOR SANITATION PERMIT <br /> - ------ ----- Permit No. - ---- <br /> (Complete in Triplicate) _ <br /> _, tR <br /> ---------------------------------------------------------- k .✓- <br /> --------------------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> 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 is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> - 1 ` <br /> r � iYG' --------- ------------- ---- --- ----- <br /> JOB ADDRESS/LOCATION _�-/ �---.�,�-.- ��- CENSUS TRACT <br /> Owner's Name _� _5. -------�_-----��� �/� fG----E-------------------- ------------------------------ -------- Phone ----- ------------------------------ <br /> Address --------� til ------------------------------------------- " . City ---- ----------------------------------------- <br /> Contractor's Name 'r-----S.7-,_�5---------------------------------- }------ ---------.License # --- Phone <br /> Installation will serve: Residence ❑ Apartment House�❑ Commercial ❑Trailer Court ',❑ <br /> N. Motel ❑Other -------------- --------- ------ , <br /> Number of living units:__._!_.------ Number of bedrooms _ _ ----_--Garbage Grinder -//Q.-- Lot Sze --------------- � <br /> Water Supply: Public System and name -- � - ?�----- ------------- _-__------.----____---Private El <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam .E] <br /> Hardpan ❑ Adobe W-Fill Material ------------ If yes, type ---------------------------- , <br /> * K <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 [ I ' SEPTIC TANK [ ] Size----------------------------------------------- Liquid Depth -------------------------- 11 <br /> pi. : <br /> Capacity ---- - Type -------------------- Material---------------------- No. Compartments ---------------------- <br /> Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------------------- ` <br /> LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length _------_---.--_-_-_.--_.__-- <br /> 'D' Box ------------ Type Filter Material --------------_--_.Depth Filter Material .--------_----------.----------_--- <br /> Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line --------.----------_-- <br /> SEEPAGE PIT [ ] Depth ------- ------------ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No i❑ <br /> Water Table Depth ------------------------------------------------Rock Size ------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -.------.--------_.--- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------------------------_-_-----) <br /> Septic Tank (Specify Requirements) -------Q=/5-a --------11_6--- A:,.m� �E--�'Z`5----ell, <br /> Disposal Field {Specify Recluirements) --------------------------------------------------- ---------------------------------------- -------- <br /> ---------­-------- - ----- -----i------------------------------- = <br /> ------------------------------------------------------------------------------------------------------------------------- <br /> : L {Draw existing and required addition on reverse side) <br /> I hereby certify that I have,prepared this application and that the work will Abe done in accordance with San Joaquin ] <br /> u 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 pens n such manner <br /> as to b77-7 <br /> b;ect to Workman's Compensation laws of California." -J <br /> Signed --- --------------- -------------------------------------------- Owner <br /> BY ... f <br /> ---- --------------------------------------- ' <br /> ---------- Title ----------- ---------------------- ---- ------------------------ <br /> (If other than owner) + <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - DATE _-.. r�----------- <br /> BUILDING PERMIT ISSUED ---DATE ---------- <br /> ADDITIONALCOMMENTS ---------------------------------------------------r---- ---------------------------------------- ---------------------------- ---- <br /> - --- ------------------- ---------------------------------------------------------------- ------------- ----------------------------------------------------------------------------------------- <br /> _ --- ---- <br /> 11 <br /> --- f <br /> ------------------------------- ---- <br /> Final Inspection by- -------- ----�- - Date -- '-�- --�(D-- ---- <br /> T �} t -- - e <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M. <br />