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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. 7-L----`'------- <br /> -------- <br /> ------- -------- (Complete in Triplicate) <br /> ".�• _ .' <br /> ---- - ------ -------- p Date Issued <br /> This Permit Expires 1-Year From Date Issued / pvc� p� <br /> p <br /> ---- z (` <br /> it to construct and <br /> e work <br /> Application is hereby made�5o the Son de in compliancelcwit al eCounalth DtytOrd Warict rn a No. to- <br /> and ex sti g Rules tand hRegulationsrein <br /> described. This application <br /> -' <br /> -CENSUTRA S CT <br /> JOB ADDRESS/LOCATION Phone <br /> - <br /> Owner's Name ._ J»"/ -------- <br /> Address <br /> •------ S�K' <br /> _ _ cit - ------- <br /> Address ---- ---- `'--� ---- 1 -------------------- <br /> ----------------- ------------ .. . Y -- -------------- <br /> �! <br /> i <br /> �] ------=------- license # 3 5- Phone `] <br /> Contractor's Name _-_ --�` - ' _ --------- <br /> + r r r: ; <br /> Installation will serve:' 'Rdsidence partment House Commercial ❑Trailer Court ',❑ { <br /> Motel'❑Other --------------!---------------------- ------ <br /> Number of living units------------- Number of bedrooms .Garbage Grinder !�_ 5---- Lot Size -- ---- ------ - <br /> Water Supply: Public System and name _____' / Private <br /> I <br /> Character of soil to a depth of 3 feefi: Sand'❑ Silt❑ Clay ❑ Peat El Sandy Loam ❑ Clay Loam [D <br /> ' Fill Material _ _ if es, type ------------- ----- ----- <br /> Hardpan [_ Adobe <br /> F t <br />€ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be plaed on reverse side.) {� <br /> NEW INSTALLATION- (No septic tank or cseepage pit permitted if public sewer is available within 200 feet,) <br />! SEPTIC TANK (Lr1 � Size--Y-=-h = Liquid Depth <br /> PACKAGE TREATMENT [ 7 <br /> Ca acit ` - <--- Type <br /> __ Material-_-- --- - ---� No.:-Compartments '_fi -------------- <br /> ---------- <br /> Capacity <br /> --------• -- <br /> P Y j-�----- `. <br /> Foundation __- ---a-- --------- Prop. Line __ -..--=--••-- <br /> Distance to nearest., Well _______��-:�------------ <br /> r � J <br /> ,* -"- Total Length --- -------••- <br /> 1 ' — ------ Length o each line------r-0---- - <br /> -.'LEACHING LINE jyi I No. of Lines ---------- <br /> ----------------------------- <br /> JI <br /> --------- -- 1 , a� <br /> ` e Filter Material + !------Depth Filter Material __- ,1'' ----------- <br /> j D' Box __:l: Type a <br /> t � I ��� --------- Property, Line =�---............... <br /> Distance to nearest: Well _�---------- ----- Foundation _.- ""-- - <br /> Er <br /> 1 3 -- -- Number ------`.t� Rock Filled Yes No n� <br /> SEEPAGE PIT ( J Depth _ = - -, Diameter 1V <br /> y # Water Table-bepth6v­ <br /> ---------------------Rock Size -.�_-�'s. _t�_.------- <br /> i (s►'[7 Foundation _ - -- Prop. 'Line ._�..-i-•-•••... <br /> Distance;to earest: Well �------ - - <br /> I i Date ------------------ ) d <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------------- <br /> Septic Tank (Specify <br /> Requirements")_.` ----------------------------- --------------- d <br /> r <br /> Disposal Field (Specify Requirements) ---_---- f <br /> P R <br /> t4 = ---------------------------------------------------------= ------- <br /> ----------------------------------- -- --------- �.} --------- <br /> = --------------------- ------------- --- --------------- <br /> "" ------- - " - - I Draw existing and requ�irediaddition on reverse side) <br /> I <br /> h have pre�iared'tliis application and�th ' the work will be done in accordance with San Joaquin <br /> I hereby certify that <br /> County Ordinances, State Law's; and Rules and Regulations of,the San Joaquin Local Health District. Home owner or licen- C <br /> sed agents signature certifies the following: n <br /> l "I certify that in the perfofmance'of the work for which this permit is issued, (;shall not employ,any,person in such manner <br /> as to become subject to Workman's Compensation laws of'California." <br /> t t - <br /> d <br /> Signed --------------------------- - --------�=_-_-°--•--•Y-W' ---------- --------- -•--- - Owner G - <br /> - - Title - ------- ------ <br /> (If other t n o Wer) V,, ' <br /> y --FORT DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - - DATE ._3:0'1- -�a- <br /> BUILDING PERMIT ISSUED DATE <br /> ADDITIONAL COMMENTS ----------- ----------------J------------------------------------------ --- <br /> ------- ---------------•- <br /> -- <br /> ---------------------------- - ---------------iT „ <br /> ----------------------------------- 7 7 . <br /> - ------- - -- <br /> Fina1 Inspection -- ' ` ---- ------ te ---------4--------- <br /> SAN JOA <br /> ---- a <br /> ! QUIN LOCAL HEALTH DISTRICT, <br /> E. H. 9 1-'68 Rev. 5M ' <br />