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FOR OFFICE USE. <br /> APPLICATION FOR SANITATION PERMIT <br /> .G - �....._......1.p:. . _. - S-a <br /> (Complete In Triplicate) Permit No: ..7. ........_..... <br />.........................f._. '.._.-__....i_._._........ <br /> Date Issued h—...z2 <br />......................... .....- `....._..._.. This permit Expires I Year.From Date Issued ""' <br /> Application is hereby made to the San Joaquin Local Health District �or a permit to construct and install the work herein <br /> described. This application is made in compliance with/County. Ordindrfice,-No. 549 and existing Rules and Regulations: <br /> Cti <br /> JOB ADDRESS/LOCATION .._....__., `Ia_------- .. ..�.����.... .............:............CENSUS TRACT ..... .................... <br /> Owner's Name ...........� ...... ... ...... <br /> ........................................,......._.__....:/...�..,....... .....Phone <br /> Address ........................ _ �../ 1......._.. City .. -- ......._...................---- ---•-•--............... <br /> Contractor's Name ..... . .. .�7.D` ._..._ ..... . ........................................License #cam'/ .,1 -- Phone -, <br /> Installation will serve- Residence ❑Apartment House F❑ Commercial ❑Trailer Court ❑ <br /> Motel ❑Other ..................................- ........ <br /> Number of living units_____________ Number of bedrooms .._.........Garbage Grinder .._......... Lot Size ............................................ <br /> Water Supply: Public System and name ......................................................-.......................................................Private ❑ <br /> Character of soil to a depth of 3 feet: Sand 0Si)t❑� Clay E] -Peat❑ Sandy Loam C] Clay loam ❑ <br /> Hardpan ❑ Adobe [l Fill Material -------- If yes,type ............................ ; <br /> (Plot plan, showing size of lot, location ofsystem 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 TANK I ] Size................................................ Liquid Depth ......................... <br /> Capacity ____________________ Type ......... Material........:.........._.-. No. Compartments <br /> Distance to nearest: Well ---.---------• ---.._--•_--........Foundation ...................... Prop. Line • ---------_.__--.--- <br /> F <br /> LEACHING LINT= f'{j No. of Lines ........................ Length of each line............................ Total Length <br /> 'D' Box ... Type Filter Material ....................Depth--fifter-Material ------_..................................... <br /> Distance to nearest: Well ........................ Foundation ........................ Property Line ....................... <br /> SEEPAGE PIT ( J Depth Diameter ................ Number ..._._.__._ ................ Rock Filled Yes [] No ❑ <br /> Water Table Depth •._z......Rock Size <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date : ....................... -----) <br /> Septic Tank (Specify Requirements) .................•--........... ..............I.................t.. . .... ... ............._ r:-...-••--•-_-_..._ <br /> Ole <br /> Disposal Field (Specify Requirements) .. _. .... ...... .. - .. . .................... <br /> -- ------ f-G _ fir^—t -­ ...................... <br /> .......... ;,r --- -_ - --------------------------------- = ------- -•---..._._.... .................. <br /> (Draw existing and required addition on reverse side) <br /> I hereby cgrtify__that_I have prepared this application and-ihat the"'work will be don* in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health-District.'Horne 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 ---------------- ----- ---• -..__ Owner _. <br /> By ........................... - ' r._��C����R <br /> .....-----... _.. Title .... . ... /1��,��11 ..................................... <br /> (if of -r <br /> hon owner) <br /> ARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ...... ... <br /> ------ -- ---••••-_--_------....-----_--•••-----•--- •-_....--_...------•----.. DATE .. ._-.�: . ar......---...__. - <br /> BUILDING PERMIT ISSUED ........ .. ....... .. ... ............ .....DATE .......................................... <br /> ADDITIONALCOMMENTS ....... ... .. ... ... •--- ..............--............................ .................................................................__-................ <br /> ---•--------•.................•-. ----•--- --------- <br /> Final Inspection by: Date _... ._ <br /> ••..................................•----------------...... <br /> NJO QUIN LOCAL HEALTH DISTRICT <br /> E. H.13 24 1-'68 Rev. 7/72 3 M <br />