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` EOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> .. . ............... Permit Na. 7S <br /> IComplete In Triplicate! 6 <br /> -/G 7f <br /> ......................................................... This;Permit Expires 1 Year Frei" Date Issued <br /> Date Issued ................ <br /> Application is hereby made to the San Joaquin local Health District for a permit to construct and instal) the work herein <br /> described. This application is made in compliance with Count Ordinance No. 549 and exis ing Rules and Regulations% <br /> k <br /> JOB ADDRESS/LOCATION /� t`' .5 .L .. . . .. ... ... �� it- it ..... .`... S TRACT .......................... <br /> Owner's Name .-. _'' �..f?� .._... ^i''..C. .............................................. Phone ......... ... ....................... <br /> Address / ' > <br /> ..............................City .��4"J`s�':�'"�... .. ........... ............ . <br /> Contractor's Nome 4t!s ---------•--•--- •.............................License d.;;L, .... phone-... <br /> Installation will some: Residence GgIK�a rtment House Commercial[3frallor Court 0 <br /> Motel❑Other........................................... <br /> Number of living units:..-/.... Number of r _ .........Garbage Grinderl ..... Lot Size ......... <br /> Water Supply: Public System and name ......... <br /> aa / <br /> ....�(1�•. ...................................................Private Q <br /> Character of soil to a depth of 3 foot: Sand D ilt❑ Clay [( t❑ Sandy Loam 0 Clay Loam Q <br /> Hardpan❑ Adobe I 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 I)available within 240 feet,( <br /> �j, <br /> PACKAGE TREATMENT ( ] SEPTIC TANK Si Liquid Depth .I. Zz.-...........V <br /> % ` .... <br /> Capacity -- - Type -P� --- Material ... o. Compartments .... ........v' <br /> 1 p � <br /> Distance to nearest: Well ... ..................Foundation _��........... Prop. Line .. .. ......... <br /> LEACHING LINT: No. of Lines g <br /> E c —e . Len th o;roch line ��`..... Total Length ..............'D' Box C �..5..- Type Filter Mater'al . lite ..Depth Filter Material .` ��............................ <br /> All. <br /> Distanc to nearest: Well ..N� -------- Foundation �.............. Property Ltne 's.................. <br /> .. . <br /> SEEPAGE PIT Y Depth ..DY---... Diamet ..�. Number ..... . <br /> ... Rock Filled Yea No <br /> Water Table Depth -....-.• ... ........_ <br /> j .............Rock Size .. .,� .�.._ <br /> Distance to nearest: Well ......� ....................Foundation /Q.......... Prop. Line ....I .. ...... <br /> REPAIR/ADDITION(Prov. Sanitation Permit# -.--.-----------------------------.......... Date ..................................) <br /> Septic Tank (Specify Requirements) .....................----------•-........._............----................•..---.._............................ ........................... <br /> Disposal Field (Specify Requirements) ............... . <br /> ------------------------------------ ----------------- ------- .......................... .....................•......................................................... ................................ <br /> .............---................................. ---------------•--......................-............_.................. --•---....------.............----.. ..................................... <br /> (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 Hoollk District. Home owner or Ncew <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is Issued, I shed( not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ------------- - ---- ---------------•-------------------•---------------- Owner <br /> other the owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ... DATE (o � ." <br /> -•-- ----•-••----•--•------•....._.. <br /> BUILDING PERMIT ISSUED _--------- DATE :.-:.-:: - <br /> ADDITIONAL COMMENTS ............... - ............... _- ---....................- - •-- .. .. <br /> �c -------- <br /> - -- ------ <br /> ----_ ....... r <br /> ----- •....... .. ----- •. •••• - ------------ ....... ------- <br /> Final Inspection by: .-----• -- : . - C` _� <br /> kyr---•--. .......���.,.,�....... ......_. . <br /> ,i 2a 1-bti �` SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7)t 3M <br />