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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT /0 7� <br /> Permit No. .._�.-.•`....... <br /> ........................-•--- ------------------ (Complete in Triplicate) <br /> 76 <br /> Date issued ..��.....':.:... ' <br /> ..................'.........:..:• :_ p <br /> ...................... <br /> ............. <br /> ...._._.._...__. <br /> This Pernilt Expires 1 Year From 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 /> r d CENSUS TRACT .......................... <br /> JOB ADDRESS/LOCATiON ..... , ,��• , {l�. .. ,f <br /> ,P.4 ---.....---•••• •... ..................: Phone 7` <br /> Owner's Name _..._../ .._..._-�•r�•� - --•-• <br /> Address :_.._ .�/ !/ ...... City .... ,1�.I�1,�`........................... •. �....__... . <br /> license # llt .... Phone <br /> Contractor's Name ..- ....6_17Y7 . <br /> ' <br /> Installation will serve: ,. Residence 11 Apartment House❑ Commercial oTrailer Court 0 <br /> ❑ ..... <br /> ,. <br /> . Motel Other .........................•-•----•-----• , <br /> , <br /> r <br /> Number of living units•---1 <br /> Number-of bedrooms Garbage Grinder - -Lot Size .• ®aC �°? -•••••....... <br /> WIlk <br /> ater Supply: Public System and name ..---------•---------- .............. ..............F....._........_.........._.................... :....Priya <br /> to <br /> Clay Loam <br /> Character of soil to a depth of 3 feet: Sand o Silt{] Clay �] Peat❑ Sandy loam•_fl Y ❑ <br /> Hardpan❑ Adobe Fill Material ............ If yes,type ............... F.......... <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 /> ��or ..' ._. Li uid Depth ...�+�.��.......... <br /> ...._ <br /> PACKAGE TREATMENT f I SEPTIC TANK,Ija Size.. . s•• q <br /> r' <br /> Capacity�� Q-`----- TYp S . Moteria ,Y �No. Compartments <br /> ...= - 1 > ":: Prop. Line . .;._ ......... <br /> Distance to neprest: Weil _� .........._Foundation .� ......., g <br /> i _ � <br /> _ Length of each line.. ............. <br /> LEACHING LINE No. of Lines <br /> .•- Total Length <br /> �i <br /> 'D' Box ��5. Type filter Material -A Q!•I'C•--..Depth -Filter Material <br /> r o <br /> Pr Line .. ................ ... y <br /> - --. Diameter ... foundation :... .. _..... Property <br /> Distance to nearest;"Well�::. �...�.- <br /> SEEPAGE PIT ( Depth ---.__ Number ._.._ .-- /•••- Rock Filled Yes. No Q <br /> �7 r :'_'-.......Rock Size -_L.1�..................... <br /> I Water Table Depth .r�G -••• <br /> t . Prop. line <br /> Distance to nearest: Well _140-.. �.... - <br /> f <br /> ............. Date ) <br /> REPAIR/ADDITION(Prev. Sanitation.Permit# <br /> r <br /> ............. ........­...7 --............. <br /> - <br /> Septic Tank (Specify Requirements).-.-' .•• <br /> r <br /> G Disposal Field {Spec;#yRequirements)-__. ........_............................................. <br /> -------------------------------- - ------ ------------------------------------ .............. <br /> r ------------ .. <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'Reguiations of the San Joaquin Local Heal;h,District. Homo owner or Ilcen- <br /> seal agents signature certifies the following: + i in such manner <br /> "II certify that in the performance of the work for whish-thisyperrnit is issued,,I shall not employ any parson <br /> as to become subject to Workman's Compensation laws of California." <br /> r ........... . Owner <br /> rSigned -------------'•----- .. ---- <br /> -�---' - "�°..:_ . - Title <br /> • ---• ._.._..... <br /> i other than owner <br /> i <br /> FOR DEPARTMENT USE ONLY <br /> � <br /> APPLICATION ACCEPTED BY � --------------- )= -./a�-.;"�---3.'7�.-- <br /> ------- ---- ----- DAT <br /> DATE _ <br /> BUILDING PERMIT ISSUED ---------- •--•-----•--------------. _ <br /> ADDITIONAL COMMENTS„ _ ----------................------------------------------- ,, <br /> i ----- -•------ -------------------- ------------------ --. -- ---__-_.._-._.._..-•---- --- --'- <br /> r <br /> Final Inspection lay: .._ .. - ------------------ ............. . ............. ------------..-.......... <br /> Dutear - <br /> EH 13 24 1-68 Rev. 5 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h M <br /> �,w <br />