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_ _ FOR OFFICE USE: <br /> �QR.OFFICE�USE: APPLICATION FOR SA TATION PERMIT <br /> �: 0 <br /> Permit No.-7 -------------- <br /> --------------------------------- <br /> -7------- <br /> (Complete in Triplicate) , <br /> ---------------- - ... <br /> ------------- <br /> -------------------------- P v< Date Issued------- -- <br /> k This Permit Expires 1 Year From Date Issued <br /> -----=- <br /> ------------------- <br /> d in <br /> uct <br /> tali the <br /> Application is heteby made to the San Joaquin Local Health District for and e it t° Rultr andnReg,Regulations; <br /> work herein described. <br /> p <br /> This application is^made in compliance with County Ordinance No. 5 �., <br /> EENSUS.T,RACT� ar Y <br /> JOB ADDRESS./LOCATION ,-. >._ - Y - <br /> ` -- _ --------- <br /> Owner s Name-----._"----- +---- <br /> - - ---- ------- - �;-Y-:..�Y�,,-�- Phone <br /> i - --- ----------- ------- <br /> ------------ <br /> ------------� _ / <br /> Address_ / <br /> ��- •.-.. City `";�'� - p a <br /> I +­-A-e-4LL � _ -�-4-L--------b cense #_© � ne---- <br /> Contractors Name-- <br /> - --U------- : --f---- ---------- <br /> Installation will serve�` Residence g Apartment House ❑ Commercial ❑ tiiier Court r <br /> ❑--�Oth =--� `" = <br /> -�--�--Motel---� er """"="""`".�.."� r <br /> f. <br /> l ' <br /> i �--� ------- <br /> _-.__Number of bedrooms----__GarbagefGrinder-____-. Lot 5rze -_ 0 - <br /> Number of Ning units: s_ _- , x � <br /> + ! �. �'" t+-- - ------ ------ private <br /> Water S�p`y:,PublicSystem and name--""' '-------- <br /> Silt Cl .. Peat 11 <br /> Sandy,Loam .�,/ Clay Loam <br /> Character of soil�to-a depth of 3 feet: Sand ❑.,o ❑ Y ❑ e t a a G <br /> Hardpan ❑ Adobe ❑ Fill Material--.--------"if yes,type_-":---- --- - <br /> Ai <br /> �. �. <br /> (plot pfan; howing sine of lot, location of system in <br /> relation to wells, buildings, ec. must be' ,frrce��on�reve�se side.}3 '` �� <br /> : + <br /> septic `k emitted if ublic wer�is-ava•ilable within=260 feet] <br /> Li uld De th __J- -------------- <br /> W P `p __ g a p <br /> NEW INSTALLATION:V. (NO SEPTIC TANKr [ )e ages #' , Size---- -;��` - -��------- - <br /> PACKfilGE TREAT [ j I t <br /> R{- atarial .No. Compartments------- - ------------- <br /> F-7- <br /> -------- --- <br /> # Capacity_4c -- „ Type <br /> �r ---r <br /> - -. :0-- -'^:'' Totat ) __.Prop. Line <br /> nearest: Well._ Foun ati,on_---” <br /> LEACHING LINE [ ] Na of Lines -- egth of each line___ <br /> V Lengt f� - <br /> ... <br /> Dep <br /> Filter Material _.-_ - -- <br /> i D�Box_..-------- <br /> Box_ Materia4 ! <br /> - <br /> ;.' �--""". _ --�'�- -� - .PFO er Line------ ------------------ <br /> �R Foundation:_�------- .- P �' <br /> Dastanc+�to nearest: Wel]__- ----------•--- <br /> " — Rock Filled Yes ❑ No ❑ <br /> f SEEPAGE PIT v [ ;l Depth --" -- Diameter---------------:----Number----------------- ------ <br /> ----- -------------------------------- <br /> f --- -:---Rock Size ------ �--� i <br /> Wbter-Table'Depth. + Ar <br /> 4 sa Distance to Weare, twlNe'li------------------------- <br /> Foundation----------------- PF Line ='� 3 <br /> --- - <br /> ' - --- ---------------Date- --- -------------------------- ----) R <br /> REPAIR/ADDITION {Prev. Sanitation Permit#___- -"----- s I <br /> r t ----------=------ -------------- ------------=-------- <br /> Septic Tank,(Specify Requirements]------------- - <br /> _ . - <br /> -" -- <br /> Disposal Field',(Specify Requirements)-""--------------- --------;#- <br /> --j------- ------------------ <br /> A-1.{ <br /> = <br /> - <br /> ------------------------ <br /> ------------ - <br /> ----- <br /> --------------------------- ----------------- r <br /> ------ �------------ <br /> --- edditian on reverse side)existing-and;req�i <br /> ` . <br /> 1 <br /> I hereby certify that'I have prepared this application and that the work will be done in accordance with Sart Joaquin County <br /> Ordinances)- State Laws; and Rules and Regulations of the San Joaquin Local Health District. Home owner or lie sed agents <br /> signature certifies the following: <br /> e i which this errnit is issued, -I shall not employ any person <br /> in sucfi manner=as <br /> "1 certify that in they performa cto e of the work for P I <br /> i' -California." <br /> Si nbed mes��!L-' ""woy: "C Co laws,.of_Cal�-----Owner <br /> g � . <br /> . ' ------Title-----= ----------------------- <br /> By---- ..� <br /> 0 <br /> - --- _ <br /> (If other than owner),,) is <br /> FOR DEPARTMENT-LJSE ONLY. F # <br /> F _ 1 DATE '— ----- <br /> APPLICATION ACCEPTED BY- <br /> DIVISION OF LAND NUMBER--------------------- -------------------- -- .,_ <br /> ADDITIONAL COMMENTS------------------------------ <br /> -- ------------ <br /> -------------------- ------------ <br /> ---------------------- ---- <br /> --------- � ----- -- <br /> __ <br /> I = t --0 <br /> Final Inspection b <br /> oe <br /> F&5 21677` <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT <br />