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FOR OFFICE USE: <br /> .; FOrOFFICE USE: <br /> APPLIVFAT O FOR SANITATION PERMIT C1 <br /> 7 <br /> Permit No._ 7"�--- �-- <br /> --------------------------------------- (Complete in Triplicate) <br /> Date Issued_"//-_ -- -� <br /> j� This Permit Expires 1 Year From Date Issued <br /> Joaquin Local Health District for a permit to construct and install the work herein described. <br /> Application is hereby made to the San <br /> ce with County Ordinance No. 549 and existing Rules and Regulations; <br /> es i <br /> This application is made in complian _ <br /> k <br /> ------ ----- <br /> - --------- ----CENSUS.TRACT <br /> JOB ADDRESS/LOCATION <br /> o •.. <br /> Phone 191�-- <br /> -------- <br /> Owner's Na1: � nlSt R- 4 !� P -- <br /> Z= <br /> ip <br /> = City <br /> Address. l -� W---- -- one_PFT <br /> Contractors Name_- --------- � ------------- <br /> 4­­ ----- _ <br /> Installation will serve: i Residence ❑ Apartment House.❑ Commercial Trailer Court El <br /> ;. r.w. .._..rt.. . Motel ❑ Other---------- --------------------------- -- ------ <br /> } Number of living units ------Number of bedrooms...- __-Garbage Grinder_.._-----Lot Size-------- -----Ac�ES--------------- -- <br /> -Privae <br /> Water Supply: Public System and name----- .._---- --- <br /> _ <br /> t <br /> Character of soil to a depth of 3 feet: Sand El Silt❑ Clay DC Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br /> ' j Hardpan ❑ Adobe ❑ Fill Material-.._-_.__ _If yes,type_.-___--___---- -------------- <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:" ''';(No­septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> ---------------- <br /> _ Capacity--:1110P <br /> .. / <br /> -Liquid Depth------- Vi---a----`- <br /> PACK'AGE TREATMENT ].--; SEPTIC TANK ( Size_'-- -------------------------------- <br /> l 00l 4, ofel\lo. Compartments------ ---------------------- <br /> --�' <br /> f .. :.,.. Capacity___ , ----=Type_ prVGP_- C__MateriaFoundation_ ___---1 -------Prop. L-ine---___- <br /> Distance to.nearest: Well._.-____��� _ _ <br /> - - length Total Length. r'� ` <br /> f LEACHING LINE [i] No. of Lines.___.__:_._-- _ g h of each line.__-_-._.._ - -- --.._--- 1-------------------------------- <br /> C <br /> a 'D' Box-- J-----Type Filter Material-- --------- -------Depth Filter Material- ---------- <br /> Distance to nearest: Well. .8¢�- Fou tion - e <br /> ,�f�� Property Ling <br /> [ :f _ nda ' Filled N <br /> t._ k <br /> SEEPAGE PIT [ ] Water Table Dep`ameter-'------ Number--- -------------- ----- <br /> Roc .Yes ❑ o <br /> Depth ---= ---' ---D <br /> " . -. <br /> th�`�.�:-----------------------------------------_ -.----Rock Size-------------------------------- <br /> ------- ------- - <br /> ] 1 �. °-Foundation—_ ----- -- Prop. Line---------- --- ---- <br /> D <br /> . <br /> bistbnce.to nearest: Wel11------.._________________ <br /> f [' 3 ___ I ------------ <br /> ------ -Date_---- _ - <br /> REPAIR%ADDITION (Prew Sanitdtion Permit#--------------- ------- <br /> ------=- ----� . <br /> Se tic Tank (Spe Re uirements]___._-._._. ___�_____________________ ___.� �r <br /> p p Y q ` ------------------ ---------- <br /> r --------------------I--------------. - <br /> Disposal Field- (Specify Requirem�rats)-_-.�----------__------ _--------- , <br /> lI { ------- <br /> . <br /> ` <br /> 1 _ <br /> __-----" F.________--"-___- - <br /> istJ <br /> (Draw ex and required addition on reverse side] <br /> I hereby certify that 1 have prepared this application and that,the work will be done jin accordance with San Joaquin County <br /> Ordinances,: State Laws, and Rules and Regulations of the San Joaquin Local Health District. Horne owner or licensed agents <br /> signature certifies the following: <br /> �� i h wo k3-for which this` a mit�s.issued, I shall not;'employ any person in •such manner as <br /> certify that in the performance of t e p,... ({r <br /> ! F i I <br /> to become.subject to Workman's. Compe�aticm <br /> nla+_1 -- - - nerSigned ---- --- <br /> B t - ' -------- <br /> --- . ------------ <br /> (if <br /> _ / 3 <br /> (If other than owner) <br /> {¢ FOR 13 PARTME T'USE ONLY <br /> ----- DATE ------ ----- --- <br /> APPLICATION ACCEPTED BY_ _. - 4 v- <br /> = --------DATE:--------------------------- _- <br /> DIVISION OF LAND NUMBER----------------- -------------------------------------- <br /> ----- - - - ----"------- It <br /> ADDITIONAL COMMENTS --- - ---- - r' - - ---:m - _ <br /> - <br /> ------------------------------------------------------- <br /> � '- <br /> ---------------- <br /> _....,� - - <br /> .�:-.,�...�.-.-�-----•TM--_-_-_--------- ---- _- h -------------- -- - ate- <br /> Final Inspection-by:----- --- - - ---- ---------_ --_------- <br /> - <br /> F&5 21677 REV. 7/76 3A <br /> EH 13 24 -�-�ti.. SAN JOAQUIN LOCAL HEALTH DISTRICT <br />