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FnR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> 11r'. <br /> Permit No. <br /> -------------------------------------- ----------• {Complete in Triplicate} <br /> ---- ---------------------------------- Dote issued . � <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Lacal 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 /> JOB ADDRESS/LOCATION ./--4 .g-,g.-- C/,_Ay J r-------- .......-.........CENSUS TRACT ---- ------------------- <br /> Phone X3.1-.-- 77�7� <br /> Owner's Na .•-- --•'- " <br /> City -------•------ -.-.--•-.-•---------------- <br /> Addres .� jam---�-f J <br /> Tim <br /> Contractor's Name . _ ..___._.License #f?- ��'•--•-• Phone - -rLr -- <br /> Installation will serve: Residence�Apartment use-a Commercial GTraller Court 0 <br /> Motel []Other------•-•----- -----------------------•---- <br /> Number of living units:........(.-- Number of bedrooms _3.......Garbage Grinder t4O..... Lot Size .� <br /> Water Supply: Public System and name ----------- ----------------------- ..........------------------­-----------Private <br /> Character of soil to a depth of 3 feet: Sand El Silt❑ Clay [] Peat❑ Sandy Loam ,0 Clay Loam [] <br /> Hardpan Adobe 1j( 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 side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) f� <br /> PACKAGE TREATMENT [ ] SEPTICTANKk_ n Size__.'z�Z�.�-_ iia�.--`�- �.�-yLiquid Qepth --�- -- - ii••-- <br /> ypett«la.e - Material_Le .ss No. Compartments _..j+.._......---� W <br /> •- Capacity .��'��.--- T , <br /> Line ._----- <br /> on -.11Q- -Prop. -- <br /> Distance to nearest: Well .6._fi,-4_.-_ Foundati <br /> LEACHING LINE ' No. of Lines ...___.__.. Length of each Iineo. O. -Total Length. �•....._. t}_ ` <br /> 'D' Box ___..j_-_.. Type Filter Materiae -•-Depth Filter Material .......................... <br /> s. �..- <br /> Fours ation '"� Pro a Cine _....." ..............Distance to nearest• Well : 10--- ,: P <br /> SEEPAGE PIT [ 1 Depth -••----...----••-- <br /> __ Diameter ................ Numbe: ............1..--..-•------jock Filled . Yesr❑ No 0Water Table Depth Rock Size ----------­----------------- <br /> Distance <br /> "-•.----- -----•-----------Distance to nearest: Well ....................•...................Foundation .................... Prop. Line ................... <br /> -,.- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ."------- --• --•-•----� } <br /> Septic Tank (Specify Requirements) ------------------------------------------------------------------I- .._-•-----•-....-••••-.---••-••-••---- - <br /> Disposal Field (Specify Requirements) ........................................-•--------.._._._._........._................................................. <br /> ................... -----•-----•-- ............... ..........•-----------•..............•................................ <br /> •. ---•--. -•--- -- --------•-------•-•. -- -- -_...........-••------•-----------•-•--•------...---•••-•----.._......••--._.........._......_....---••-••-•-•-- ..................... <br /> (Draw existing and 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 San Joaquin <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: i <br /> "I certify at in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to be a subject too Work 's Co RR,, to laws of California." <br /> Signed .. -.�ctuJ(_.. ......... ¢vtn�. - ........d `'- <br /> By ................... `_.._ Title�Gt'... .. <br /> -----... ........... .. U <br /> (if other than owner) <br /> FOR DEPARTMENT USE ON <br /> APPLICATION ACCEPTED BY-------- ••-•-- --------------- --••_. t DATE ....r'`�..: ......... <br /> BUILDING PERMIT ISSUED .---. -. -. --•--- -------........................ ........_ ... ��= DATE ..-.._.. <br /> ADDITIONALCOMMENTS ....................................................... . .....----------•--------•--•--••�......... ._....................- <br /> ................................................ <br /> #STRCT <br /> •--...-•-----•-••-.....------................................... <br /> ..................................•--•--•-•-----........_.. ------------• -- --- <br /> -.............................._.. ..............................._ - -- �§� .•.... <br /> Final Inspection b ,. � �.._.Date . �_ - ---.•..-----•----... <br /> SAN JOAQUIty LO L ALTH <br /> E. H. 9 1-'68 Rev. 5M <br />