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J <br /> FOR OFFICE USE: APPLICATIOM: FOR SANITATION PERMIT <br /> Permit No. -.7�__-1/03 <br /> ----- ----- ---- ------------------'------ (Complete in Triplicate) _ <br /> -------------- ------------------------- <br /> --------------- Date Issued -------------------. <br /> - p <br /> fires 1 Year From Date issued <br /> --------- -------------------------------- - <br /> This Permit Ex <br /> Application is hereby made to the San Joaquin Local Health District for a per 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 /> JOB ADDRESS/LOCATION ----------/I - ----- ✓ - --CENSUS TRACT •---------------- -------- <br /> 10 <br /> Owners Name -------------C%��rLS-----------------�/ --------------------:---- <br /> Phone .-5� �-- Q1'/_ <br /> Address -------------- f�" J <br /> City --------- <br /> Contractor's Name ._-- 7T <br /> �f�,�_------.License #�,s�/__7,�_ Phone <br /> ���'T/-/'rf-��------ `5-,��----- <br /> Installation will serve: Residence] Apartment House❑ Commercial{,]Trailer Court 0Mot/el ❑Other ------------------------------------------ <br /> Number of living units Number Number of bedrooms -_%3-------Garbage Grinder ------------ Lot Size _---^-a ---- z <br /> Y ----C--. Y-------•--- --Tic n/ y -Private F-1 <br /> Water Supply: Public System and name - _ __ ------------------------------------------------------ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt[] Clay ❑ Peat❑ Sand Loam ❑ Clay Loam ❑ <br /> Hardpan ❑' Adobe I 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: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] <br /> PACKAGE TREATMENT [ I SEPTIC TANK.[ Size- --------- ------•---- --------- � -----____ Liquid Depth .-___-_____________ <br /> Capacity _...___ <br /> -- Type -------------------- Material---------------------- No. Compartments -------------------- <br /> Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ----------_--------- <br /> s <br /> LEACHING LINE No. of Lines -----------) g --___ Total Len th __--__ __p <br /> _____ Length of each line_-____-- ------- g <br /> 'D' Box ------------ Type Filter Material --------------------Depth Filter Material --------------•--------------------- <br /> Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ------------------------ <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ------------ --- Number ---------------------------- Rock Filled Yes ❑ No ❑ <br /> Water Table Depth ---------------------- <br /> ------------kock Size -------------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------- -----------) <br /> Septic Tank (Specify Requirements) ----------------------------- ------ ----------------------------------------------- ----------------------------------------- <br /> Disposal Field (Specify Requirements) ----------?yTa ---------7W------ ------`� `�7 _ '------------- <br /> -------------- <br /> ------- a --------- 2 t <br /> ----------------- <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: <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 /> Signed __CF6_77.1-1r ------ ------------) ------------------ Owner <br /> -------------------- Title <br /> -------------------------------- <br /> (If other than owner( <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----------------------------------- DATE -- 2- �� J_Z3----- <br /> BUILDING PERMIT ISSUED --------------------- ---------------------------DATE <br /> ADDITIONAL COMMENTS ---------------------- ----------------------------------------------------------- <br /> - --------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------- <br /> --------- - --- ------- ----- -------------------- ------ <br /> ----- ------------------------ ----------- <br /> ------ <br /> ------------- --------------------------------------------- <br /> ------------------------------ <br /> --- --- --- Date <br /> Final Inspection b ----------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'6$ Rev. 5M <br />