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FOR OFFICE USE: u � <br /> « APPLICATION FOR SANITATION PERMIT <br /> •''®fj <br /> Permit No. ..,........,:..(Complete in Triplicate) ti _• M - <br /> ........... <br /> t Date Issued .. --------=---- <br /> 4 ......................................................... This PermltExpires I-Yearfrom Datelsstted <br /> Application is hereby :Wade to the San Joaquin local Health District for a :permit •to_construct and install •the work herein <br /> described, This application is mode in compliance with County Ordinance No. 549 and.ex#sting Rules and:Reguhttlons: <br /> c . <br /> 30B ADDRESS/LOCATIONM0---- --•--:t .: U�.1 ._. ..:..............CENSUS TRACT ----- <br /> Owner's Name -------------- .__:.. Phone . ._�_9/ <br /> Address .... .................... _......d q YJ .... City <br /> _. ..�... <br /> �" ✓ S `,.." <br /> Contractor's Name -----•-•-•-••-------' %Gir -Qt...:$ s.''� Fri, ° ..License :^ done ._._ .. 7 - <br /> :................. .. _ � <br /> Installation will serve: Residence[�Apartment House U) Commercial OTraller Court 0 <br /> Motel Q Other�-------'---..----.-•-••- ---------•--- <br /> Number of=living units:_ �.__ Number ofbedrooms``- :i Gabr age Grinder ......... Lot Size .......A.2/... ----_---- <br /> Water Supply: Public System and name __ -___-- ........................ _;._-__.-...__,-:_...-____....___--....................Private <br /> Character of soil to a depth of 3 fest: _Sand 0 Silt o Clay ❑ Peat❑ Sandy Loom 0 Clay Loam 0 <br /> t <br /> Hardpan p Adobe 1% Fill Mater€af ...__. .....i5 yea,type............... ............ <br /> ar� - slue <br /> (Plot plan, showing size of lot,.location of system in relatlirUZIIs, buildings, etc, must be placed on reverse side.)yn <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} T <br /> PACKAGE TREATMENT [..]-:..SEP=TIC-TANK f ] Size....... Liquid Depth <br /> C Ca aci t- T C <br /> p ty ................. ype . Materlal...•------...;.-____.. No. Compartments <br /> � l <br /> Distances to nearest: Well ____________________________________Foundation ...................... Prop. Line •---------_------__--- <br /> LEACHING LINE [ J No. of Lines ...... ......:.......... Length of each Bate? _ ..: ..... ......... Total Length ........ -------------------- <br /> D' Box :_ Type filter Material --------------------Depth .Filter Material ..__•__•__. ........................ <br /> Distance to nearest: Well ................:....... Foundation ------:___---------•_-_- Property Line ................... <br /> SEEPAGE PIT { ] Depth ----1---------_- -- Diameter ----- -- --- Number ---------- ---------------- Rock Filled Yes Q No Cl <br /> WaterTo6e)Depth • •-•... ..................Rock Size •-- --------------...•---------•- <br /> # 1 �. <br /> Distance to nearest: Well Foundation .................... Prop. Line ................. -- <br /> REPAIR/ADDITION(Prev. Sanitation Permitt .................•---___-__._ Date ._._..: ................. } <br /> Septic Tank (Specify Requirements) .... <br /> --- ...--•• -•----•--••- �............ .........._.,. <br /> - <br /> Disposal Field {Specify Requirements} --•------------- _ -----'Y. ........ ._.. -- 7�L� ... ....... ........ � <br /> i, r r , <br /> -------------------------- <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 subject to Workman's Compensation laws of California." <br /> - <br /> Signed ------------------- -- _`________ Owner <br /> BY ............................ <br /> Title _... -_-..... .................................... <br /> (if other th owner) - <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED Y .._. 1-7:0-el---?1. ..............---•............ --------------DATE ' <br /> BUILDING PERMIT ISSUED --__-. . <br /> - DATE ......................................:.... <br /> ADDITIONAL COMMENTS ......-.-._"................... -- _--- - - I <br /> =r—=.:--------•"--•.............................. .....__....:.. --------• <br /> i <br /> -------------------------- ---------- <br /> --------------- <br /> ._.._._............---•---' <br /> - r1 . ---- <br /> Final Inspection by: -•-- —-- ------- ---- • --- •---•----...._...............-__-_----•--------- � Bate ..0 "�.��............... <br /> EH 1.3 2h 1-68 Rev. 5M <br /> SAN .#fJAQUIN .LOCAL HEALTH. DISTRICT � $I?!I 3M <br />