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� i Y <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ` Permit No. 7 - ------------ <br /> Z-0 <br /> - 3 Z <br /> (Complete in Triplicate) -----5 <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 /> { <br /> JOB ADDRESS/LOCATION .-__---- ----- _ ------ I 11 L--►_ -Un-----._.--IAS i---------------CENSUS TRACT .�?_ — <br /> Owner's Name --------------------- Lam`----- ----------------------------------------------------- ------------ <br /> --- Phone ------------------------------------ <br /> i 1 <br /> Address - ----------------------------------------- ! ------------------------------------------------------ Cit w <br /> Contractor's Name -----------------------LDU-1�°----------------------------------------=-------.License # -------- ------------- Phone -------•------------------•--- <br /> Installation will serve: Residence ❑Apartment House❑ Commercial:❑Trailer Court i❑ <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'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam '❑ Clay Loam.0 <br /> Hardpan ❑ Adobe'❑ Fill Material ------------ If yes,type _______________________-__ <br /> Y <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 TANK f ] Size________________________________________________ Liquid Depth __._______________.___.__. <br /> Capacity --------------------- Type -------------------- Material---------------------- .No. Compartments ------•-•---•-----•--- <br /> iDistance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ----------------__---- <br /> b LEACHING LINE [ ] No. of Lines ------_J_--------------- Length of each line---------- Q------------ Total Length070-____-_..__.. <br /> p .f ---- v <br /> -=-�'O ___-De th Filter Material - ----�-rS-•--- �-----� --- <br /> _ <br /> 'D: Box�•� ST'_�'TypeTFiEter�Material� <br /> Distance to nearest: Well ______ x>------------ Foundation ____cA)6-------- Property Line ------------------ <br /> SEEPAGE <br /> ---___._._.___SEEPAGE PIT y[ ] Depth -------------------- Diameter_ ________________ Number _.__._- ------------------- Rock Filled Yes '❑ No i❑ <br /> WaterTable Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well __________________________ __________Foundation _.___c_-__---------- Prop. Line ---------------------- <br /> REPAIR/ADDITION(Prev, Sanitation Permit# -------------------------------------------- Date ------------..---------------_.-_-) <br /> Septic Tank (Specify Requirements) ------- � _-I -� j lit= ( -- - <br /> -------------- - <br /> Disposal Field (Specify Requirements) --------------------------------- ----------------- ---------------------------------------------------------------- <br /> ' ------------------------------------------------------------------------------------------------ =' <br /> �. <br /> ° ----------------------------------- ------------ --f--- <br /> - - -------------------------------- - <br /> --------------------------- - -- ------ --- - ---- -------------------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> 1 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: J <br /> "1 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 becom s blect to Workm 's Claws of California." <br /> Signe ----- -�— --= Owner <br /> By4,-•------- ------- ----------------------------------------------------- --•-------------- -- Title <br /> (If other than owner) ------------------------- <br /> FOR DEPARTM T USE ONLY <br /> APPLICATION ACCEPTED BY -------------------- --------------(�� <br /> ---`--- - - -- ------- DATE --- _ _-� ----------- <br /> B ILDING PERMIT ISSUED ----------------------------------•---- ----------- --- - -- ------- -------DATE ----------------- -- - --------- <br /> ALCOMMENTS --------------------- -- --------------- -------------•-•--------------- --------------------------------- --- <br /> ------------------------------------------------------- - <br /> ---------------------------------------------------------------------------------------------------------------- :. ------ <br /> ----------- <br /> ------- ------------ <br /> ina Inspection by- ------------------ --------------- -------------------------------- ----- -- ------- - - -- - -------- Date <br /> + 0/�. <br /> SAN. JOAQUIN LOCAL HEALT iSTRlCT <br /> E. H. 9 1-'68 Rev. 5M <br />