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FOR OFFICE USE: APPLICATION FOR^ SANITATION PERMIT <br /> --------------------------------------------------------- Permit No. 7-3 -,Sd3__ <br /> - <br /> tete in Triplicate) <br /> (Com - - <br /> Date Issued <br /> - <br /> -------------------------------------------------------- This Permit Expires 1 Year From Date Issued <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/ TI N _ �� - --- -----� -�� ---� ------- --------CENSUS TRACT ..._.- ................... <br /> ;1/q -------------- - - ---- ne ----._----------------------------•- <br /> Owner's Name <br /> C = ���x <br /> Address ----------6--.�--5-- ------ -- -?--r__'-. ............ City ---- ---- ---- - ----- ---- -- - .................... <br /> Contractor's Name --- - -------- - --- - -------------- -----`--r _,_.License # 17Y31 Phone ----------_----------------- <br /> Installation will serve: Reside [ Apartment House❑ Commercial ❑Trailer Court ;❑ <br /> Motel ❑Other -------------------------------------------- <br /> Number of living units:----- Number of bedrooms _Y__Garbage Grinder _________ Lot Size --- _______................................ <br /> ------------- -------------Private <br /> Water Supply: Public System and name ______________________'�: _^-�'__--. .-------------------------- ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay ❑ Peat❑ Sandy LoamClay loam <br /> 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.) I <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size-----------------------------------_------------ Liquid Depth -_______-__.._---------__ v1 <br /> Capacity ------------------ Type -------------------- Material---------------------- No. Compartments ...................... <br /> Distance to nearest: Well _____---___________________________Foundation ------------ --------- Prop.-.line _._.....__ ........... <br /> LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length ---__-.-__---•--_----_--_-. <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 [3 No C] <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well -________________________________ ____Foundation --_-.--_____._...._- Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) <br /> SepticTank (Specify Requirements) ---- -------------------------------------------------.---------------------------------------------------------,.-----------_--•---------- <br /> (SpecifY Requirements) -- •---------- <br /> s oal Fi Id � <br /> - ------------------ <br /> C -f <br /> 1 x - !a l_ - ------------------ ----------------- <br /> (Dr w 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 /> "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 Workma ' pensation laws of California." <br /> Signed l: Owner <br /> BY - - - '<� `' - Title = ---------------' ----------------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _. <br /> -------------------------------------------------•--------. DATE4-7 ----------------- <br /> BUILDINGPERMIT ISSUED ------------------------------------------------------------------------------------------------------ --DATE ------------------------------------------. <br /> ADDITIONALCOMMENTS ---------------------------------------------------------------------------------------- --------------------------------------------------------------- <br /> ----------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- --------- ------ -- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------- --------k_7�`-7 ----------- -=------- <br /> FinalInspection by: ---- airs " ---------------• ----------------- -----------Date --------------------------------- ---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />