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FOR OFFICE USE: APPLICATION -FOR SANITATION PERMIT <br /> C:f.!�....................!1..:. _ - s <br /> (Complete in Triplictite) Permit No. ...Z. .... ... <br /> ............... This Permit Expires 1 Year From Date Issued 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. 544 and existing Rules and Regulations: <br /> y I <br /> JOB ADDRESS/LOCATION .:. n.... .....................................................CENSUS TRACT .......................... <br /> Owner's Name . .. .......... . .............. Phone .................................... <br /> Address ----1,I'lP. x/ <br /> ~�.. ..�+�•e .._...-- -------- --/----•------------------•... City . 7..................... . ........ <br /> Contractor's Nome ...A?/720._- ,f [ .<. .. ...........................License # ,1f7v"10­.419Phone��? ::n-2 ./. .... <br /> C <br /> Installation will serve: ResidenceN Apartment House❑ Commercial ❑Trailer Court C] <br /> Motel ❑Other ............................................ <br /> Number of living units:.. .. .. ... Number of bedrooms ._. Garbage Grinder/vEr .. Lot Size ................. <br /> Water Supply. Public System and name ....--••-.•-- ----- ------------.__...----------..........------------------------.._......---............Private K. <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay LoomA, <br /> Hardpan ❑ Adobes'' Fill Material ...........0 If yes,type ......I..................... <br /> (Plot plan, showing size of lot, location ofsystem in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: INo septic tank or seepage pit permitted 11 public s 0"wie F is available within 200 feet,) <br /> PACKAGE TREATMENT { ] SEPTIC TANK Size . .................. Liquid Depth ............ <br /> Capacity/4�.A ..... Type"-.00z ....�. Material •lei .`-.___ No. Compartments .. ' <br /> �00Distance to nearest.• Welles Foundation 1fQ_Ile .4' p. ...s.l, <br /> ......... .......,................ .... -• ------• Pra Line ... .......... <br /> LEACHING LINE ) No. of Lines ........2.._.......... Length of each line...... total Length 17Z-7.. ............ <br /> 'D' Box Jl.W?-0.. Type Filter Material ./.: ._ Depth Filter Material /, ? <br /> �� .� —/ s <br /> Distan a to nearest: Wel! .., ............. Founi�a#.ion .....-......... Property► Llne ._ ter........ <br /> SEEPAGE PIT ( j Depth ._l..a.......... Diameter `X_!XZe_ Number ..... -................ Rock Filled YesA No O <br /> e� Water Table Depth __-U�r`'r.~ Rock Size .............. <br /> Distance to nearest: Well ...._./ ...................Foundation .,/'/ ....... Prop. Line � �.... ..... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ) <br /> Septic Tank ISpecify Requirements( <br /> Disposal Field (Specify Requirements) ._..._.............................................. <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: <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 ................... .... ...... _ tea.........._. Owner <br /> By ......................... �_.......................... Title . . ..e. . ..... <br /> .............. <br /> ............... <br /> (If of than owner`' <br /> EPARTMENT USE ONLY / <br /> APPLICATION ACCEPTED BY DATE ...... ............. <br /> BUILDING PERMIT ISSUED............. ... . <br /> . . :- •-- ........ ..............................................:..............DATE ........................................... <br /> ADDITIONALCOMMENTS ............ ....... ... .............................. .................................................................................. <br /> ... . . ---•---------------------------••-••---.........................._••-••-•-----........................------------.... ........ . <br /> •---------------------------------------- ---•-- . ..... . ............................................................-----------•--•-----------------.. ... <br /> Final Inspection by: j�� <br /> Date ..... �/7.... <br /> S� JOAOUIN LOCAL HEALTH DISTRICT <br /> E. H. 1.3 24 1.'68 Rev. 5M 7/72 3 M <br />