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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ------------------------------ - Permit No.7�_- -°_7 <br /> S ------------- ----- <br /> -. (Complete in Triplicate) <br /> {� <br /> lJ Date Issued_/p_�_�'-- � <br /> y1------ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION----7,77 7------- --- ------ ---------- t <br /> -- -;--.--.----.CENSUS.TRACT - - ------ <br /> Owner's Name ----------- ----- --- -- --- ---. - - -------------------- Phone ---- ---- --------------------------- <br /> Address <br /> ---- ------ t -- <br /> ----- ----- <br /> --- Cit A c- -Zi ---------- <br /> Contractor's <br /> - `---- <br /> i <br /> Address_..-------����'..--- - � ��'";��----- - �_ - - � - <br /> Contractor's Name1►7�_L �9. ./; _f' __ i4rEi' .�,� ____ ,k_�.,f. .�'__License #_.� -. - -___Phone_ � `�":_�_, "� _ ' <br /> ._._ <br /> Installation will serve: Residence Apartment House=:❑� Commercial ❑ Trailer Court ❑ <br /> .- <br /> -6-Motel.-❑.. Other--------------------------- ---- --- <br /> i01 <br /> Nu#tuber of living units_______ _________Number of bedrooms____.__( f __C cbage Grinder._.____..' ___Lot Size_ .___ .. D� __ ___----- ___________ <br /> Water Supply: Public System and nome_-__ --------------------------------- ----- ---------------- ---------- ------------------------------ ---------------Private,X <br /> Character of soil to a depth of 3 feet: : Sand ❑ 'Silt ❑ Clay ❑ ` Peat❑ Sandy Loam 0 Clay Loam ❑ <br /> C Hardpan E] Adobe X Fill Material---------__If yes, type-----------------,..___.__._. { <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must beYPlaced on reverse side.) <br /> NEW INSTALLATION: INa"se ptic ta n k-o, F seepage pit'permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ j SEPTIC TANK­-W- ".t Size___��,�`_�_ -""�`""Ciquid Depth.___ --------------- <br /> t <br /> # k - _....i. i. 5 <br /> - � Capacity--��-�--��---TYPe=--=---==-=-----------Notarial--- - ------- -----.No. Compartments--=------- .-------------------- <br /> r +a r <br /> �. Distance to nearest: Well-----�_,��'...__.._____ __:___._:.__Foundation_.-----.__,'___________Prop. Line----3_.+¢'---__---------- <br /> __�, <br /> LEACHING LINE,. ,. [,l No, of Lines-i-=--------- .,-----Length of each .Iins..,.-'----------------a--------Total Length------- <br /> ------------ �t <br /> i `D' Box------------Type Filter Material ____ ------- Depth Filter Material__---------_--------- -- -------- - -_ ._-------- <br /> Distance, <br /> ___Dis#ants to nearest: Well----.------------____________Foundation_._;_____ _+_'__----___Pro 'erty Line.._---_--- --__` -----____. <br /> Stepp [ ] Depth---- _ ____._Diameter.;-QRock Filled Yes X Np,❑ Y' <br /> r ; <br /> Water Table Depth -------------------------------------- <br /> _d <br /> ,r r <br /> . P - --------------=--------------------------------Rock Size --���'' ------ ---=-- -- �� ---- <br /> 4 Distance to nearest: WeIL°___._- s F <br /> Foundation_.)__, ". ' Pro 'Lirie___ <br /> REPAIR/ADDITION (Prev. Sanitation Permit#_______________ - # t 4 <br /> P (Specify q ate---=----------'--- =f---- Y ) <br /> .... rt <br /> Se tic Tank ecif Requirements)uirements)-----�-�.-�` � �t����-- --_��___�_-- = 1 - - - - -=�- <br /> Disposal Field (Specify Requirements)-.: .A--, __ _. - aE-" 4w r ----------------------------------- --------------------- +t <br /> f <br /> -------------------------------- -------------------------- <br /> hereb certify that i have prepared this application and that the work will be done-in act s <br /> (Draw existing and required addition on reverse side) v f <br /> y y p p pp � accordance with San-Joaquin-Country <br /> Ordinances, State Laws, and Rules and Regulations of`the San Joaquin Local Health District, Home owner or licensed age' <br /> signature certifies the following: ' , <br /> "I certify that in the performance of the work for which this permit is'issued, .l shall not employ any person in such manner <br /> to .become uNbit.to Workman's Compensation laws. of California." # <br /> Signed . Owner <br /> BY--------- ------ ------------------------------------------------------ <br /> ---=------------ ------=------=----- ------- ------------------------------- 'Title----------------------- ------------------------------------- --------------, <br /> I (!f other than owner) <br /> FOR DEPARTMENT tJ `ONLY - <br /> �� 3 <br /> APPLICATION ACCEPTED BY---- d-------------- =- - - -- -----------------------DATE <br /> DIVISION OF LAND NUMBER---------- --- ------ - ----- � -. � - _ •. = -DATE--------_.---...- -----"------------ <br /> ADDlTIONAL COMMENTS----------- ; -- --------------- ------- ----------=------- ---- ------ -.--_--------------------- --------- --------------------------------- , <br /> I <br /> ---------------------=------=--------=------------------------------------- ------------- ----- <br /> ----------------------------------------------------------------------- -- ------ -- <br /> E <br /> -' ------- --- -- -- - ------------------- <br /> Final <br /> � <br /> --- --- -------' <br /> -----j----- ----- - -------------------------------------- ------- <br /> Final Date------ -- <br /> EH ,{[ <br /> 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fss sia» Rev., ne aM+ <br />