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FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT <br /> ...... ...... / i <br /> Permit No.� <br /> (Complete In Triplicate) - /., <br /> .. . ..... _..... Date Issued :a7� <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 incompliance with County Ordinance No.549 and existing Rules and Regulations: <br /> q IW <br /> JOB ADDRESS/LOCATION ��•i��•• ��•.-...rr� / D`.--�� �..............................CENSUS TRACT .......................... <br /> Owner's Name ........ r. /_•_._..YG�.�__... ...... .. .. ............. .....................................................Phone <br /> Address ........ k� 1 -------- - ice . ..............City ......................................... . ........... <br /> Contractor's Name ----- -- .... .........:..........s....... ..._ --------License lilt' d.- -J _ Phone ..7.� ..`.1 7 <br /> i <br /> Installation will serve:- Residence Apartment House 0 Commercial OTraller Court 0 <br /> Motel ❑Other <br /> Number of'living units:­­,_ <br /> Number of bedrooms ..-...Garbage Grinder .........:.. Lot Size ...... .................... ........ <br /> Water Supply: Public System and name ... . .............. .....�.-----.............._..------�.................._._...._.....---.._.. .Priya <br /> Private <br /> Character of soil to a delith of 3 feet: Sandt],, Silt[] Clay ❑ Peat❑ Sandy Loam o. Clay Loam❑ <br /> T Hardpan Q,,*" Adobe❑ Fill Material yes,type <br /> #Plot plan, showing size of lot, location of system-ini relation to wells, buildings,,etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No Septic tank or seepage pit permftfied`if public sewer is available ilihin 26 feet,) , <br /> PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size................................................ Liquid Depth ...................... r <br /> Capacity -------------------- Type -•.................. Material......---------------- No. Compartments .....................- 6 <br /> Distance -to nearest: Well ....^...............................Foundation ...................... Prop. Line ............._ ....... <br /> • Total Length�lrACI�ING-"LiNE'[ ] No. of lines ..........!'=Length of each line-----------------......._.. g ............................ <br /> 'D' Box Type .Filter Material .....................Depth -Filter Material ............................................ <br /> 4 <br /> Distance to nearest: Well ._... .Foundation <br /> -------------=--•-• .............. m.... Property line ........................ <br /> SEEPAGE PIT [ j Depth Diameter ...... Number ............................ Rock Filled Yes ❑ No Q <br /> Water fable Depth -••-••......--••-•.......:.....Rock Size ................................. <br /> Distance to nearest: Well Foundation Prop. Line <br /> REPAIR/ADDITION(Prey. Sanitation Permit '. .......::...................... Date .................................. p <br /> Septic lank (Specify Requirements) ---- --- .-- �. - ....... <br /> Disposal Field (Specify Requirements) ------ ------- -•---- -r--- - ....... <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certify that l 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 Locat 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, 1 shall not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ..... •-------- - -- --------.. .._ s. Owner <br /> By .... ---- -- ------ - ..........0 �-------- ........ Title ---- ----------------..__... <br /> r <br /> f of r an owner) <br /> A��"RTMENT .USE ONLY <br /> APPLICATION ACCEPTED BY ---- ---------------------------------------------------- DATE ... . .- .. <br /> BUILDING PERMIT ISSUED --------- .._ -------DATE .......:................ --.--:_... ._.. <br /> ADDITIONAL COMMENTS -•--• .. ----•- •. ... ........-------------------------------------- ......... ----...._.. :.. <br /> te <br /> Final Inspection b 4 - ---------------------- -------Date <br /> P y- -------------- --- --r <br /> EH 13 2h 1-68 �ev�. cjM SAN JOA LOCAL HEALTH DISTRICT 8/7h- 3M <br />