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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -7,,LL Z <br /> Per No. .......7......... <br /> .. <br /> , (Complete in Triplicate) <br /> _....-.4.............................................. <br /> s Date Issued .................... <br /> ��. This Permit Expires 1 Year From nate Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is mode In compliance with County Ordinance No. 549 and existing Ryles and Regulations: <br /> 4' . � . �,. <br /> f 7 . . <br /> CENSUS TI2/lC:l <br /> JOB ADDRESSJLOCATION ._,.. _....-•�---.�................... .. .._.... .. .. �. �. ••---...'.�..... . <br /> JJ Phone-:.. :.. .......:........Ph ...._._ <br /> Owner's Name _. _ --_-- <br /> Address ---___........., �.5 .f.............�i� ....... City ......._.................. .........._ ..... .. <br /> ... <br /> I ...... <br /> .._....7.............................License # .�� .. Phone =!_.� <br /> S -� X4 <br /> r f <br /> Contractor's Name .._ _. ' •'�- �••�� �• <br /> Installation will serve: Residence ❑Apartment House Com ercial'[Trailer Court 0 <br /> Motel [l Other ..... �... .. - <br /> Number of living units:.._ Number of bedrooms ...%4..�!Garbage GrinderLot Size <br /> Water Supply: Public System and name ............: -•-•-•-••---•--•••••----•....------- ......... ,-••••• ...........Provo te <br /> Character of soil to a depth of 3 feet: Sand D Silt j] - Clay Peat❑ Sandy Loam -0 Clay Loam <br /> 'Hardpan ❑ Adobeii{ Material If yes,type -----.. _--------------_ <br /> (Plot pion, showing size of lot, location of. system In relation to wells, buildings, etc. must be placed on reverse side.1 <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TR T j � SEPTIC TANK SI .' .S�.rl�•/� ................ Liquid Liquid Depth ...... <br /> � . <br /> Type <br /> Capacity ._... yp /I�• Material _ . Compartments ...... <br /> 1 sw .. Na <br /> ` '`� Distance to nearestz Well Foundation 1.. Prop. Line ..-� <br /> • ••-• ... <br /> ev <br /> I LEACHING LINE � No, of Lines -- �_ ........... Length cf each line._...��............ Total Length _._ ...................:... <br /> D' Boxy_e�3-- Type Filter Mdteric#1 r ...Depth F#Iter Material ............................. <br /> :... <br /> _. .. Fl <br /> Property Line . ---...._.!•...__..._. Z <br /> Distance to nearest: Well ...... Four(dation <br /> ••-� , . <br /> Rack Filled Yes No <br /> SEEPAGE PIT Depth _. 01:57...._.._ Diameter .,;a:_�NumberT.---• �-••---........ �r o-9177♦ <br /> Water Table Depth ._. �:Q.:::- - .%..".......-..?...Rock Size <br /> Distance to nearest;N ell �.!}Q..................Foundation .---,/..�-........ Prop. Line --- ---.........__...� <br /> ••--.. Date .. ....•----1 <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ..:................................... ..----........... ._.._. ,. <br /> Septic Tank (Specify Requirements) ..............................-------------•--.............................T.............—_-------- -- <br /> Disposal Field (Specify Requirements) ............ ....................•-------...........••--.._.............•-----_........_-----------------_-- _-......,_.._. <br /> .........................•---••...................................................................................................... --•---------.....------------•.......---------.........-•------... <br /> .. .....................................................................---................................_......................................... <br /> ,', 'I (.Draw existing and required addition on reverse side) <br /> 4 i :4 <br /> I hereby certify that 1 have prepared .this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, anti-Rules,a_nd 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 /> SignedOwner <br /> k By ............................ <br /> ......... . --.. , ........................... Title ...-- .. •••-":`�" '..•..........__....... <br /> (If oth a ownerI <br /> FOR DEPARTMENT USE ONLY <br /> DATE �'� <br /> APPLICATION ACCEPTED 8Y7 '•"........... <br /> I BUILDING PERMIT ISSUED . ..--_.... ..................DA ................._................_........ <br /> ADDITIONALCOMMENTS •--...........................................•------•............I._........---------._...... <br /> € ...............................................:............. ............................................. ................................................•••.................__..........••-- <br /> Final Inspection by: ....:..... ..•--• --- ,.......:. D <br /> ate <br /> SAN JOAQ AOCALHEALTH DISTRICT <br /> z v <br /> 7/723•M <br /> 13 24 ,_-An 2.., 5M <br />