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FOR OFFICE USE. a <br /> APPLICATION FOR SANITATION PERMIT <br /> v _ ,....... ,.....:':._........ Permit No. .7 r 7` <br /> (Complete In Triplicate) ... <br /> This Permit Expires 1 Year From Dat*Issued Date Issued .. ...1.`.7. <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 /> J08 ADDRESS/LOCATION ...... vL.._YI - . e. ".....W.. � c-�....---.• --CENSUS TRACT <br /> Owner's Name ..._..,.. ... ................ _ .--•.. .................Phone <br /> - • LtY .................. .. <br /> Address71-7 <br /> Ci <br /> Contractor's Name . ....license #e :~jj` �f Phone , .�L <br /> Installation will serve: Residence A r <br /> I ,� pa tment House-E] Commercial ❑Trailer Court ❑ <br /> 4 <br /> Motel ❑Other .............•--... <br /> I q <br /> Number of living units:- ....._�_ Number of edrooms ..L..____GarbO a Grinder ...-. - „•, <br /> ��.� Lot Size .-��i.'... . ...I��..._ . <br /> ......... � �yc.� <br />{ Water Supply: Public System and name _._. .—.� -C.....__�tJ`G�Gr-�J ..__.....................•--....---....-----.........---Private ❑ <br /> i Character of soil to a depth of 3 feet: Sand Silt 0 Clay ❑ Peat EJ Sandy Loam ❑ Clay Loam ❑ <br /> lHardpon.C] Adobe Fill Materiol 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,} <br /> PACKAGE TREATMENT ( SEPTIC TANK.t ] nze..... ............. ...........:._._ liquid Depth .......................... l� <br /> 'Capacity ; #. Type --- Material..:_... - .... No.' Compartments ...................... <br /> Distance to nearest:: Well .. ..................................Foundation s.._ . ...... Prop. Line .....----------....... N <br /> LEACHING LINE No. of Lines _ .. /. .,.. _. .. Length of each line _.._ ..._...,.--, Total length -l}1 ................ <br /> --'D' Box; ,.: Type Filter Material .. ! i ------- <br /> Distance <br /> - - <br /> ....Depth-,Filter.Material_;:�j�_�_--. •�. - .........:.....t'� .,� <br /> r .. , <br /> Distance to nearest: Well .. . �'. ____._ Foundation // .�., ,_,-••-„•_-- <br /> _.. ..l. .----.-.--•...._ Property Line _. <br /> SEEPAGE PIT Depth ' r <br /> p ., .�-.. Diameter .------ Number ..._._.�...:..... .. ... Rock Filled Yes ' No ❑ <br /> Water Table Depth ........_1.Q_.1.................. c / <br /> ......Rock Size .... ----------- <br /> l <br /> Distance to}nearest: Well ../.Gtl ___--_Foundation Prop. Line 4` <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- ------------------------------ Date _._.................. ............ i <br /> Septic Tank (Specify Requirements) ._.......� .__.. ....__._. ...._ °Disposal Field (Specify Requirements __... .. . -3a <br /> 'iE ........ +lam <br /> I <br /> .. . .... ...... .. . <br /> ----------------------­­................... ,...:.. <br /> f ........ ... .. ........... ...... ------- ------------------ .......... ---.......... .............................. <br /> (Drdw existing and required addition on reverse side) 1 <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: s <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 /> � i <br /> Signed _ ......... <br /> Owner <br /> .. Title <br /> ..---••----- ----- <br /> By <br /> I of er than owned <br /> FOR EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ... <br /> BUILDING PERMIT ISSUED .............. <br /> ADDITIONAL COMMENTS ...... �/ DATE . . ...... <br /> ---.... ............ ........... <br /> .. ,....._.......:.... ._.................._....... -------------------- <br /> ........... . --- - ------------------------------------------• .......__....- .............. .----............. __....- <br /> .----•-•-- •-------------- ----------------------------- .......... .........._............. .................._... _ ....---............ <br /> .. <br /> Final Inspection 6y: ........ . .................. Dot .. ... ` <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> - E. H.13 24 1-'68 Rev. SM o Z W <br />