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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT < <br /> o _ <br /> - � P -------------- � Permit No. -7 - ------------- <br /> --------------- <br /> A T <br /> QComplete in Triplicate) <br /> -------------------------------- --------- -------------- This Permit Expires 1 Year From Date Issued <br /> _." "_ <br /> Date Issued -Y <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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION _- -- --- ------11-11 ik), -----------------------CENSUS TRACT -------------- ........... <br /> Owner's Name ------- j_ '� <br /> ���r/ t`- �� �'�=�-�1-�------------------------------------------------------------ <br /> _ -.Phone -- -- <br /> Address -------------------------------------- City/7���12«�1 <br /> / ----------------- ------------- <br /> Contractor's Name ----- _ /_ �� 'J ____.License Phone <br /> Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ;❑ <br /> Motel ❑ Other -------------------------------------------- <br /> Number of living units:--------- _ Number of bedrooms ___''—Garbage Grinder ------------ Lot Size _____________________________:__-----____ <br /> Water Supply: Public System and name ------6-t.cZy1= = 'r(_i�5--------------------------------------------------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand' - Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay 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.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size__ ___________________________ ______________ Liquid Depth ________-_-___-,______-_-- <br /> Capacity ------------------- Type ----------------- -- Material------ ---------- No. Compartments ...................... <br /> Distance to nearest: Well __-___________ ____-_-_________-_F undation _________________. Prop. Line ...................... <br /> VII <br /> LEACHING LINE [ ] No. of Lines ____________________-__ Leng of each lir)4-____- _-_-______-__-______ Total Length ,____ ................... <br /> - rn <br /> 'D' Box ------------ Type Filter Mat rial ___________-f _ _Depth Filter Material __________________________________________ <br /> Distance to nearest: Well ________________________ F,pundation _____ ------------------ Property Line ........................ <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter -------------- Number ---------------------------- Rock Filled Yes ❑ No i❑ �. <br /> Water Table Depth -------- ------------------1(----------_------Rock Size -------------------------------- <br /> Distance to nearest: Welt -----------------___________--_______Foundation -------------------- Prop. Line ....................... <br /> A <br /> ) <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- <br /> 9 <br /> Septic Tank (Specify Requirements) -------------------------------------------------------------------------------------------------------------._--------------------------- <br /> DisposalkFId Specify Requirements) _________ ____- ----- / �� =" r' Z= T----- ------ <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 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 t Workm % Compensation laws of California." <br /> Signed --F -- ----------- - - Owner <br /> K <br /> BY - ----- ---� �----� _r- Title ---------------- ------------------------------- ----------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -------- ________`L e__ _ _ ----------------------------------------------- DATE _____�_`-_?__7'_� 7 <br /> BUILDINGPERMIT ISSUED ----------------------------------------------------------------------------------------------------------DATE ------------------------------------- <br /> ADDITIONAL COMMENTS ------------------------------------------------------------------------------------------------------------ ---- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> 4 ------ --------------------------- <br /> ---- --- - <br /> 2Final Inspection bY: -------------- -- ----- - --------------------_ Date % --`--- --- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />