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FOR OFFICE USE: D�E7r�3� to <br /> -APPLICATION FOR SANITATION PERMIT ,/ <br /> ------------- -- ------------------- ---- - --------- u � Permit No. 7 � _ <br /> (Complete in Triplicate) <br /> --------------------------------------------------------- <br /> ---------------------------------- - <br /> -_-__.----_--_____ This Permit Expires 1 Year From Date Issued Date Issued - _ - � <br /> ��Z �' i1✓t�H� / . <br /> Application is hereby made tot a San Joaquin Local ealth D'istrict for a permit to construct and install the work herein. <br /> described. This application is made in compliance with County Ordinance No. 5/449 and existing Rules and Regulations: <br /> yF _ 6t �' 'i �SUS TRACT -------------- ----------- <br /> JOB ADDRESS/LOCATION ____ _ ___ _ ____��E':^; _�____ <br /> Owner's Home440-#0` <br /> j ----- - <br /> Phone <br /> Address ------- ------------------------------ <br /> City ------------- ----------------------•--...- <br /> Contractar's Name _. --_.License =� <br /> G �/ f # Phone <br /> Installation will serve: Residence Apartment House,D Commercial ❑Trailer Court <br /> Motel E]Other __________________ <br /> ------------------------- �N , <br /> Number of living units------ Number of bedrooms A--_-_--Garbo e 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 <br /> Hardpan ❑ ' Adobe A 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 /> TREATMENT E: SEPTIC TANK, Size__�_ ` F �� <br /> PACKAGE / <br /> � l �] ^� �� � - ----•---------.. Liquid Depth �� --------------- <br /> Capacityf < TypeLA ',e✓ Materia! ____ No. Compartments __ ------------ <br /> Ir fl, A . <br /> Distance to nearest: Well _ ° '�� ____________________Foundation .�p___._________ Prop. Line -� ______ <br /> LEACFIING LINE No.. of Lines —----------------- Length of each line___10e_.�._________ Total Length/ 1j_ _.--..--_._.-- <br /> oy <br /> 'D' Box*�---- Type Filter Material, Depth Filter Material��_____.__________________________v-- <br /> Distance to nearest: Well �---.__-_--___ Foundation _114'`--------- Property Line ------------------ <br /> Depth <br /> - -.-- � <br /> SEEPAGE PIT Depth _. ,� _ _-- Diameter<t_ Number ____1----------- ------- Rock Filled Yes No <br /> . � ------ r <br /> "r i <br /> Table Depth. ----e"17�--------------------- -----_Rock Size �+__�__--____--- ----- <br /> 'Water ; <br /> '61. ! � ; <br /> Distance to nearest: Well __ _ _____________________Foundation _ - ---__---- Prop. Line -!Z---------------t .! <br /> REPAIR/ADDITION(Prev. Sanitckton Permit# ---------------------------------------- Date _______:_______________________-_-) <br /> Septic Tank (SpecifyµRequirements) -------------=---- ----; ---------T.---- ------------------------------------------------------- ------------------------=- f � <br /> Disposal Field (Specify Requirements) ------------------------------------------{{-=: '-----------------------------------------------------------------------------------'� <br /> 1 7 it _ J <br /> aN <br /> i (Draw existing and required addition on reverse side) <br /> I 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 /> "Ilcertify that in the performance of the work'for which this permit is issued, I shbll not employ any person in such manner <br /> as to become subject to Workman's Compenscitifon laws of California." <br /> Signed ------------------ ---- ---------------------------- --- Owner <br /> ------------------------------- / <br /> By. ---.% Title t� / . <br /> i <br /> (If of r t an'owner ,' i <br /> J , f FOR DEPARTMENT USE ONLY <br /> APPLICATION CCEPTED �BY ..: . -- ------E. �----------------------------- -------- ---- -------------------- DATE ---- a,�-----�v--------------- <br /> BUILDING PERMIT ISSUED -: - ---t---------"'------------- ------------------ -------------------------------DATE ------------------------------------------ <br /> ADDITIONALCOMMENTS = ----------------------- ------------------------------------------------------------------------------------------------------------------------ <br /> n _ <br /> --------------------- ----- ---------------- - - - - <br /> Final Inspection byC- ---" -- ------- '" --' Date <br /> t SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />