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FOR OFFICE O'e1 APPLICATION FOR SANITATION PERMIT <br /> �- Permit No. 7 <br /> .................................. (Complete In Triplicate) <br /> --..-.-,._....' -••---•............................ : . Date issued <br /> This Permit Expires i Year From bate issued <br /> Application is hereby made to the San Joaquin Local Heth alth <br /> District <br /> i triOrdinance for <br /> permit <br /> t and existing Rules and Install <br /> the Re workoh rein <br /> described. This application Is made iP�ompliance <br /> JOB ADDRESS/LOCATlON .-` ' -g?r�f ...-....C. !`.q�+.SF'S..-....._ Q140.................CENSUS TRACT .......,.,.......... <br /> ._.... I <br /> .............. <br /> ..Phone ........ <br /> 7 _._..City .......rr.L�........-.t-��----------------..................... <br /> -- �=__B.0_x..._.9 - <br /> Address -.. ---- �..,.- <br /> Contractor's Name --------------------- <br /> ----License # ----------..---- ----- one -------------------------------- <br /> _..----•----------------- -- <br /> Instailation will-serve: Residence 0 Apartment House(] Commercial[]Trailer Court 0 <br /> a� <br /> `Motel Q Other ----------------• -----•- - ---.------ ; <br /> P Q_}14 -------------- <br /> Number of living units:....11..---- Number-of. bedrooms ............ Grinder :vis--- Lot Site __Z-. <br /> R Private <br /> Water Supply: Public System and name ..._DEEP-,.•...y,t.�.4:r�. Sand Loamn ` Clay Laam i ate , <br /> peat Q ❑ <br /> Character of soil to a depth of 3 feet:.....Sand'0;- silt[{ clay ❑ Y .--•.• i <br /> ! r <br /> ' Fill Material If yes e <br /> Hardpan�� Adobe[) , ,type <br /> ...........:... ...... <br /> ............ <br /> G (Plot pian, showing size of lot, location of system in relation to wells, b�i(dings, etc. must be placed an reverse side.) <br /> NEW INSTALLATION: '(No septic tank or seepage pit permitted if .public sewer i available within 200 feet,) <br />'fI`• y.n - �...-,--_... -.4 - ,. <br /> ^c- <br /> ----��-j- - <br /> ._.. .. <br /> ,, <br /> S}Ze------- <br /> Liquid Depth <br /> PACKAGE TREATMENT; SEPTIC TANK a2-tI.Y:-----• <br /> ce -- Material rNo. Compartments ••... .-Capacity TYpe -------_ Prop. Line ---- r...:_..._.. <br /> . <br /> Distance tonearest: Well ------- Foundation <br /> ��/ a4 .......... <br /> LEACHING LINE of Lines �---.... Length of each line.-..-- -. '•-----"'•--- <br /> Ua <br /> Total Length ---- <br /> DBox ......./... Type Filter Material Is ' [- <br /> �� <br /> 4tepth Filter fVlaterial .........../. ............••.-•---......_. <br /> r <br /> Distance to nearest:Well J�.G...fi.... Foundation .- ••� - •-.... Property Line ... .................. <br /> Depth -- ��Rock Filled Yes NQ <br /> SEEPAGE PIT �" -.ca7..�_...._- Diarrieter" _. _._ "Number'" ''-``- • . <br /> �. Rock Size ...../= <br /> Water.Toble Depth ----•------•-----� r <br /> t , � �p �}- Q_ :". Prop. Line <br /> I Distance to nearest: Well ..._:.-.--.��-------------------••..Foundation .....- <br /> RIEPAIR/ADDITION(Prev. Sanitation Permit# Date -•-------••--• ) __.. <br /> ---•-----•-.. <br /> =`.:..::......... ................... -•..._.._......---- <br /> Septic.Tanlc S eci Re. uirementsj <br /> - : .._-----.-_ <br /> Disposal Field (Specify Requirements) ....................•--•---------•-- <br /> ---------- ----------­--------- ..................... <br /> --- ---- --- --- - - - -------- <br /> ------ ----------------- - <br /> - iDraw existing and required addition on reverse s'sdej <br /> I hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin <br /> l County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health Distritt. Herne owner or licen• <br /> sed-agents signature certifies the fallowing: <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 hec a subject to Workman's Co ansa an laws of California." <br /> Signed ._.. Owner <br /> Title --- ------------ <br /> --------- -------------- ... ..._ <br /> (If other than owner) <br /> F It EPA MENT fJW ONLY <br /> r APPLICATION ACCEPTED BY ----------- - - <br /> '� - -------•- DATE r -�-� --------- <br /> APPLICATION <br /> BUILDING PERMIT ISSUED -------- ------------------------------------ ----- ------ -----------------I . ........ <br /> DATE -.. •... .......... ...................... <br /> yr -------------•- ---------- --•----- -----------•- --------••---------•-•---- <br /> - -- ------•--••......................... <br /> ADDITIONAL-COMMENTS ----------------------- ---------- ................ .. -------•--------•-............. •--- .... -••---......... <br /> w' ... Date j---------------- <br /> Final.Inspection by: . ?._� .. -----............ ... <br /> - --------- " y <br /> EH 13 24 1-68 dev. 5M N JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br /> F - <br />