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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> "= - Permit No. _7J- <br /> (Complete in Triplicate) <br /> This Permit Expires 1 Year From Date Issued <br /> Date Issued <br /> _ _ <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 County Ordinance No. 549 andexistingRules and Regulations. <br /> JOB ADDRESS/LOCATION ` --- � CENSUS TRACT <br /> Owner's Name .J`'� � 'J ----�----------------------------- Phone <br /> � o <br /> Address _� . l- '---- City --- - -------- ---------------------------- <br /> Contractor's Name ---__ -- -- -------------- _ License #p�- 4 .17. -. Phone "~ - " <br /> Installation will serve: Residence ❑ Apartment House-[] Commercial IR7railer'Court 1❑ , <br /> Motel ❑ Other -----------"- -------------- , <br /> Number of living units:---- ------- Number of bedroomsZ '"_Garbage Grinder ------------ Lot Size.- , r <br /> Water Supply: Public System and name --------------------------- Private <br /> Character of soil to a depth of 3 feet: Sand'[] Silt.❑ Clay E] Peat ❑ SandyiLoaml❑ Clay Loam 'E] <br /> ____V__'Hardpan ❑ Adobe. Fill Material -------------If yes,type ----------------- <br /> (Plot plan, showing size of lot;.location ofrsystem in relation tomwells, buildings, etc. must be placed on reverse. side.)`, <br /> NEW INSTALLATION: (No septic tank or.seepage pit permitted_ cif public sewer is available within 200 feet,) , t <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [z}� Size ' /oz1�--- -- - -------------------: Liquid Depth ----y__--_-.--_,----- <br /> i Capacity 4,R-0-0------ Type1T- -_& - Material No.' Compartments ------------------••-- <br /> -Distance to nearest: Well --------- - -----_------------Foundation --------- Prop.'Line ---`�-_--, : <br /> LEACHING LINE [ No. of Lines ---------/------------ Lengfh�of"ead7"line'- --�'y"'"° 'Total Length _$�Q----------_----I <br /> 'D' Box .------- Type Filter Material S-- Sr--Depth Filter Material -----1-e------ - -------------------_- <br /> f 1 4- - f <br /> bistance to earest: Well -__ --�__------- Foundation 1U--- ------ Property Line. - ------------------- <br /> SEEPAGE PIT [ i)epth - s---f Diameter __------ Number ____.___,1--- Rock filled Yes No .C1 <br /> Water Table Depth --------15�e--`-----------------------------Rock ----------•-•---- <br /> Distance to nearest: Well ----------------------------------------f=oundation ----- --------------- Prop. Line ----------------•--•--' ;I <br /> A <br /> REPAIR/ADDITION(Prev. Sanitation.Permit{�# -------------------------------------------- Date ------------------------------------- <br /> ` <br /> Septic Tank (Specify Requirements) `-- -------------------------------------------------- ----------------------- -... <br /> 4 ----------------------- ----------- ------------- ------------------------------------------------------- <br /> Disposal Field (Specify Requirements) {----------------- ----- -�. , <br /> 6� ----------------------'------------------------ <br /> ----------------------------------------------- <br /> 1 ' $ ,. t } ---------------------- <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, Slate Laws, and ,Rules and Regulations of the San Joaquin Local Health District. Home owner of 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 beco�subbi!ct_tWorkm n's Compensati.on laws of California." ; <br /> L �,. <br /> Signed - = ---� --------- Owner ( �� ? <br /> i <br /> BY - ! Title ----- ---------------------- ----------------------- ----------------- <br /> I <br /> (If other t an owner) _ <br /> FO PARTMENT USE ONLY / f <br /> APPLICATION ACCEPTED BY -., - -------------------- ---- ------- - DATE /= � r . �--------------- <br /> BUILDING PERMIT ISSUED -----,- -- / DATE ---------------------------------`---------- <br /> ADDITIONAL COMMENTS ; `, -- ------ --- --------------------- � � <br /> /� xl -,----------------------------------------- ------------------------------------------- --------------------------------- f <br /> --------- ---------------------- <br /> 314? <br /> y <br /> 314? Final Inspection by: APro N JOA------------------------------------------------------- -----------Date <br /> C r� / QUIN LOCAL HEALTH DISTRICT <br /> `.G� -dor LSfCA'1~V <br /> E. H. 9 1-'68 Rev. 5M <br />