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APPLICATION FOR SANITATION PgRMIT� <br /> ..........�...............:................................ x , pfete In TrIpllcatsl Permit No. �.:...7 6. <br /> lGant -` <br /> .......... This Permlt Expires 1 Year From Dale hsued Date Issued �G <br /> ...... .;. ...... --•.... <br /> Application is hereby morale tothe San Joaquin Local Health District for a permit to construct and Install the work herein <br /> described. This application Is made In compliance wi;h County Ordinance No. 549 and existing Rules and-"Regulations: <br /> JOB ADDRESS C <br /> /LOCATION ...........:....., ..._...........----•----•--........----•-.....-- ..................................CENSUSTRACY <br /> Owner's Name .... .. .x...Xf......... ..... .............. ...............•--..........._ n ... �........... <br /> f Address ... :. ..: �.�..._. .. ............. ... ............................... . ......... <br /> Contractor's Name <br /> ....: ... ------------------------------------------.License # R—Z'5 . Phone /�- <br /> installation will serve: Residence FrApartment House C] Commercial❑Trailer Court ❑ �.... <br /> Motel ❑Other........................................... <br /> Number of living units:...... ----_•Number of bedrooms --x;2-....Garbage Grinder -_-..- Lot Size �......................... <br /> fWater Supply: Public System and name -� �� �� - .-----.......»...... ....._.. -----•-------.Private <br /> Character of soil to a.depth_of Meet; Sand❑` -Silt❑ Clay .❑ Peat Sandy .. ❑ <br /> ❑ ndy Loans ❑ Clay Loam ❑ <br /> : Hardpan❑ 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: 1No septic tank or seepage pit permitted if public sewer is available within 200 feet,} <br /> eACKAGE'TREATMENT ( ] SEPTIC TANK{ ] Size.................... ...._.................. Liquid Depth <br /> ..... ........................� <br /> Capacity .................... Type .................... Material---------""......... No. Compartments <br /> ...................... <br /> Distance to nearest.• Well ..Foundation ...................... Prop. Ina <br /> LEACHING LINE l No. of Lines . .... ..:........._LengfIf'6f rebc'h 1 ...................... T o . ! ................... <br /> ine �`'°`�` Total Length <br /> 'D' Box ............. Type fatter Material ..:............... .Depth Filter Material ........ ... <br /> Foundation ........ <br /> ..:. ....... -Property-Line............................................ <br /> Foundation <br /> SEEPAGE PIT [ Depth .... ! ...:..... Diameter Number �. <br /> .......:..... ,....:.............. Rock Filled Yes ❑ No ❑ <br /> r Water Table Depth ................... ...... ............ ....Rock Size ..................----.......... <br /> "SDlstance So nee est:,Well_ .:_ ........:..: T:_Foundation ............ ....... Prop. Lime ......... .......... <br /> REPAIR/ADDITION(Prey. SanitationPermit <br /> r ............... 'Bate .. ... = .-•} <br /> Septic Tank )Specify Requlrmenta) • -. ..... _... l <br /> -4 <br /> 7i_srsosal Field (Specify equiroments)._ .._...._. ._ .:. _�.. ..,z .. �� <br /> � '• ,�:l.- __`rte?fir'.. '-------•-••-•----•........................... <br /> ---...------•--•• . -----•-•----•---------• - <br /> - ...............:..... <br /> (Draw existing and required addition on reverse :Ede} <br /> I hereby certify that I have prepared this applicadbn and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regufallons of the San Joaquin Local-'Health-Dlstdd:Horne-owner-or licen- <br /> sed ingents signature certifies the following:_. h � " <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 beU- su <br /> lett ork an'i Compensation laws of California." <br /> �nec' ..... .................. 4_ •..... .................:Owner <br /> By ..............------ .tri '`" - ... 7itte <br /> ..... = ........... ... ... .................................................... <br /> (If other than owner) , <br /> EOARTMENT USE ONLY `�, <br /> APPLICATION ACCEPTED BY ..._... DATE .... `r..:, . .. . ...... <br /> .......................... ....................... ...._ <br /> BUILDING PERMIT ISSUED ......... -...........I.............................. .:...........DATES <br /> ADDI ZONAL COMMENTS ...... .. ... .............. ..._.. <br /> ._. .�....... ............7. ............................. ........................................-_...._........................_............_..... <br /> .. ................. ........ <br /> Final b Inspection P Y ...... ..................................................................Date .G ......... :� :.,.:. ..........._... <br /> EH 13 2Ja 1-66 Hov. 5m ...'_. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7b 3M <br />