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14 — _ POFFICE USE <br /> APPLICATION FOR SANITATION PERMIT 7 <br /> Permit No. <br /> ---------- ----------- ----------------------- (Complete in Triplicate) 7- <br /> Date Issued <br /> This Permit Expires. ear'-From'Date Issued <br /> ------------------------------ -------------------------- <br /> Applic'aflon is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> descr'ibed.-,This application is made in compliance with County Ordinance No, 549 and existing Rule's and Regulations: <br /> __..__CENSUS TRACT ----------------- -------- <br /> JOB-ADDRESS/LOCATION ---------55��Plj?' <br /> Phone ------ <br /> Owrfe�.s-,Name --- --- --------------------------- ---------- <br /> -------------------_-- <br /> City� <br /> ---------------- <br /> Address � = <br /> --------------------Licen'se # ------ Phone <br /> Co 'ctor cime <br /> mra <br /> t <br /> `;.Installs <br /> ion will'serve. Residence Apartment House'E] Commercial :E]Trailer Court :E] i <br /> —Mote I.-E]-Other------------------------ ----------- -------- <br /> Nomber of living units________ ____' Number.of Plroqmsl -___Garbage Grinder ------------ Lot Size -------------------------------------------- <br /> riva <br /> WaterSupply: Pyblicsystem,ancl name ---C: -------------------------------------------------------------------- <br /> Pto E] <br /> Character of sail to a depth lof.3feet, :-:,5and'E] Silt'E] Clay 0Peat E] Sandy Loam ❑ Clay Loam 'Ej <br /> q <br /> __-__Hard1pari0,? Ado Fill Material ----­­__ If yes, type ---------- ----------------- <br /> t <br /> (Plot plar;i showing size of lot, localion 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 /> 1 .1 ------ Q) <br /> PACKAGE TREATMENT SEPTIC SANK'{ 1 Size------------------------------------ ---------- Liquid Depth -------------------- <br /> ----------- <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 /> Type Filter Materia!---------i------------Depth Filter Material -------------------------------------------- <br /> Distance to nearest: Well -----I--.-----_:r------ Foundation ------------------------ Property Line ------------------_--- <br /> SEEPAGE PIT Depth --------- ---------- Di amete ------- Number --------------- ------------ Rock Filled Yes E] No C] <br /> Water,Table Depth ----------------------------- .-------Rock Size --------:�;--------------------- <br /> Foundation -------------------- Prop. Line --------_-------_-- <br /> Distance to nearest: Well ------- ------I------- <br /> --------------------- <br /> REPAIR/ADDITION(Prev. Sanitation 4rmit# ------ -------------------------------------- Date ---------------- ----------------- <br /> Septic Tank (Specify Requirements),,__------ --------------------------------------------------------------------------------- --------- --------------- <br /> Di sal' <br /> ----- <br /> Dismosal' Field (Specify Requirem6nts) 1=A111--- ------ ff&r...... <br /> ---------- <br /> - ------------------------------------------------------------ <br /> (Draw existinglVno 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 Son Joaquin <br /> County Ordinances, State-Laws, and Mules and Regulations of then 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 manner <br /> as to become-subject to,Workman's Compensation laws of California.o " <br /> Owner <br /> Signe ---------- -------------------- A <br /> ............ ............... <br /> 111 <br /> Title ------- <br /> 7 <br /> B <br /> (If other than owner) ) <br /> ADT&ACMIr <br /> F USE ONLY <br /> APPLICATION ACCEPTED,BY - ------------ -- ---------------;--------------------------------------- DATE ------/..... ......7------------- <br /> ----------------------------------------- <br /> DATE <br /> BUILDING PERMIT ED - , : _ _ __ - I <br /> ------------------------ ------------ <br /> ---- --- <br /> ------R-ZPlll^------ -- ----------------------- <br /> TS ---- ------ -------- <br /> I ADDITIONAL CO, IMEN <br /> ----------- -- -- ----- ------------------------------ -------------------------- ---------------------- <br /> ------------­­--------- ----S___--------------------------------- ­--------- <br /> 7 --------------------- <br /> --------------- ------------- -------------------------------- ...... <br /> -------- --------------------- <br /> _/--------------- <br /> Final Inspection by ---------------------- <br /> ---------------Date ---- ---- <br /> ----------------- <br /> • SAN—JOAQUIN-6rL-(DC�A;L—HEAt-T-H—DISTR C <br /> E. H. 9 1-'68 Rev. 5M <br />