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FOIL OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ----------- <br /> ----------------------- --------------- p Permit No. --�-�---5-�-.y <br /> (Complete in Triplicate) <br /> ----------------- --------------------------------------- <br /> Date Issued <br /> - <br /> --------------------------- This Permit Expires 1 Year From 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. 549 and existing Rules and Regulations: <br /> fiV <br /> JOB ADDRESS/LOCATION _AY j� l - --- --------------------------- <br /> ----- - -------- CENSUS TRACT ---_-_-•----- <br /> _ � -� -✓'----- ---- ---- - -- <br /> Owner's Name -----� ------ f a J�!n!-----------= -------Phone Jr----------••-•-------_---- <br /> Address ------- ------- • 'fid '----------------------- City _49010110"V-- --------------------------------------------------•--•----- <br /> Contractar's Name _:/�1110k_ —"_ - ------------------------------------------------- -------------License # ---------- ------------ Phone ------------------- ---------- <br /> Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court i❑ <br /> 4 <br /> Motel ❑ Other -------------------------------------------- <br /> Number of living units:_____----- Number of bedrooms ---9---__Garbage Grinder --____ Lot Size � ....9''i=-------------------- # <br /> Water Supply: Public System and name --------------------------------------------- ------------------------•---------------------------------------Private ' <br /> Character of soil to a depth of 3 feet: Sand❑ Silt ❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loarq,k�r <br /> Hardpan4?1 <br /> Adobe ❑ 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,) <br /> PACKAGE TREATMENT SEPTIC TANKSizelf -----_-- ' - ------------- <br /> a <br /> ------ Liquid Depth _$7------------------- <br /> Capacity/4" <br /> ----•------------- <br /> CapacitYL �---miType ^_ MaterialNo. Compartments --- '---- -------- <br /> ----- ------------ <br /> Distance to nearest: Well -- P47-----------------_.__Foundation IV------------ Prop. Line 4---________..__-__- <br /> LEACHING LINE No. of Lines ---aX'_-------------- Length of each line /I --------- Total Length -1"" ---­------- <br /> 'D' Box �&..4_ Type Filter Material ---------Depth Filter Material _ --------------------------------- <br /> Distance to nearest: Well __/dW-------------- Foundation _/0--------------- Property Line 47----------------- <br /> SEEPAGE P#T 4} Depth _ _,'�'___ Diameter _`__2'_'#__ Number -____-___-* -- Rock Filled Ye No C <br /> Water Table Depth1,X-�------------------------------Rock Size - ----------------- (� <br /> 40 <br /> Distance to nearest: Well -�'+"--------------------_-___-Foundation __/0----------- Prop. Line*''._._----------------- <br /> REPAIR/ADDITION{Prev. Sanitation Permit# -------------------------------------------- Date -------------------•--------------) <br /> SepticTank (Specify Requirements) ------------------- -----------------•-------------------------------------------- -------------------------------------------------------- <br /> DisposalField (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: <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 ubject to Workma Znsatilon laws oIF California." <br /> Signed - ------ --- r � �wner <br /> BY ------------------ -------------------------------- Title <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ./ ------------------------------------------- -------------- DATE ----'-----e'71 ----------------- <br /> BUILDINGPERMIT ISSUED ------------------------------------------------------------------------------------------=---- ---------DATE -------------------------------•----------- <br /> ADDITIONALCOMMENTS ----------------------------------------------- ------------------------------------------------------- ----------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------- ----------------------------------------------------------------�;----------------------------------------------------- ---------------------------- <br /> ---------------- _ <br /> Date ----�`---- -------=-- <br /> Final Inspection bY: - - - - - -- ------------------------- - --------------------------------------------------------------- �� ---- --- - -- ------------------------------------- <br /> ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />