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44 <br /> FOR OFFICE,ISE:j -APPLICATION FOR SANITATION PEP-MIT Permit No <br /> ....................... ------- <br /> lComplete In Triplicate) <br /> Date Issued <br /> This Permit Expires 1 Year From Date Issued <br /> --- ------- <br /> — ---------- <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 C my Ordinance No. 549 and eost5*ng Rules and Regulations: <br /> W", D4 <br /> pmrTRACT .......................... <br /> JOB ADDRESS/LOC#TTYN ................ ....Phone.---------•------------------------- <br /> Owner's <br /> ------- -------------------- <br /> ............................... City a?......................................... <br /> ZP I&. <br /> ,Owner's Nome <br /> Address ...../15-f........ Phone <br /> ..........z........License ....... ......... <br /> Contractor's Nome .......0 <br /> thstallation will serve: -Residence;4Aportment House[] CommercialoTrailer Court ;0 <br /> Motel [7 Other........ ----------------------------------- <br /> --- <br /> Number of living units "Number of bedrooms ----A..Garbage Grinder A'AP.. Lot Size X- ------------------- <br /> - <br /> Water Supply: Pijblic System and name ........................................................—------------------------------------ ......Private <br /> Character of soil to ci depth of 3 feet- SarrdX Silt C] Gay [] Peat El Sandy Loom -[I Clay Loom [I <br /> Hardpan Adobe-7 Fill M6teriol .............If yes,type ............................ <br /> (Plot plan, showing size of lot, location of system in relation to,wells, buildings,. etc. must be placed on reverse sideT <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> r - h <br /> PACKAGE TREATMENTSize i.... . ....... Liquid Dept ----------- <br /> 4- No. Compartments .--ATn............ <br /> [ ] SEPTICTANK-0 <br /> Capacity TYpe,,R!,We.. . ....... Material Line-A <br /> Distance to nearest- Well ......... ---...F6undation -- -------Prop. Li <br /> .0--- <br /> ...... ..... <br /> LEACHING LINE N6. of Lines ---/-*............... Length of :Pch line.__.-._--... ........... Length ............ <br /> X Total <br /> 'D' Box W-40.. Type Filter Material /-."*eDepth Filter Material ./V----------•----- ---•-- ------ <br /> ---------- Property Line __fry__...,_._... <br /> Distancelo nearest. Well ............ Foundation X'V­0 .... <br /> 0 <br /> SEEPAGE PIT. Depth .... 0 Diameter ... Number ..­y.e...i.................. Rock Filled Yes No <br /> able Depth ... ........... <br /> Water T ......Rock Size ..­---­------­-- ........ <br /> Distance-to nearest: Well --,-"P-0.......................Foundation 'e...... Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ---­----­-----------!­­....... Date ---------------------------------- <br /> 1 .---------..-..... :.Tank (Specify Requirements) -------- ---------- <br /> ,4 1 , -X/- --------------------------------------------"----------------- <br /> Disposal Field (Specify Requirements)_-:----.---•-.-_-_-. ------ - .... ................. •................ ..............................................I......... <br /> ...... ----•-------------------•--•-•-----•----..... .......................... <br /> ............ <br /> ........................................... ................­­­---------......... ------- <br /> .............. ...... --------- ....... M___ --------------............... ..............................­­...................................... <br /> is (Draw existing and required addition on reverse side) <br /> I her hot the work will be done-in accordance with Son Joaquin. <br /> hereby certify that I have prepared this application and t <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, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ............... .. .................................. Owner <br /> ----------------�4.......... <br /> ------------------------------ <br /> By ...... .................... #Or -.V.01 <br /> Title .... p <br /> (if �- er�thor owner) <br /> FOR DIPAItTMENT USE ONLY <br /> APPLICATION ACCEPTED B ------ ....................................... DATE ......... <br /> BUILDING PERMIT ISSUED ......... ....... ................. ............... .......DATE .......... .......................... <br /> ADDITIONALCOMMENTS ..•... ..... .............................. ........ --------- .............................................................. --------------- ------ <br /> ..............I-------.......... --------­--- ......... ­.................I.....................I.......... ..............................­­.......... ....... ............... .......-............ <br /> ............................... . - -­ ­ --- ---------------------------•----------•--•••-- ----------------- ......................... .......-----­--------------- ---•------•---------- <br /> ............................ - --1 ........ ................•................................./0­19�p, <br /> ........... .......... <br /> . ............ <br /> .............. Date ----------- <br /> Final Inspection by: <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />