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i' FICE USE: <br /> APPLICATION FOR SANITATION...................� ON PERMIT <br /> fCon►plete in Triplicate! Permit No 7 ---•_-- _-_!. <br /> .t.� ._ <br /> Thlx Permit Expires t:Year From Date Issued Date Issued/Q.-`-' q <br /> Application is-hereby made to the San Joaquin local Health District for a permit to construct and install the work herein I <br /> described. This application is made in compliance with County Ordinance No. 549 and existing.,Rules,.a_nd�•-Regulotions: <br /> �. - s...✓.��.., . <br /> �s <br /> JOB ADDRESS/LOCATION <br /> / � s� <br /> Owner's Name �-- - :"" ...... ._+...._ <br /> v -� S TRACT <br /> y %== .Phone ... �3-•---- �d7 <br /> Address •---•--•-••-------. <br /> ]�; . •----•--...--- City . ..._ �..... ..t 4, <br /> Contractor's Name ._J'.J.i�1.tPlYa, - pi <br /> ........................License �•l • G=- Phone <br /> Installation will serve: Residence©Apartment HouseIj Commercial oTral ler Court 0, <br /> F Motel❑Other...... ....................:.....:.. <br /> . <br /> Number of living units:_.._-_-- Number of bedrooms <br /> _...C,arbage Grinder ............ Lot Size _.._1� s._.... <br /> Water Supply: Public System and name ' <br /> ..Private <br /> Character of soil to a depth of 3 feet: Sand El Silt 0 Gay ❑ Peat o. Sandy Loom-ir Clay Loam �� <br /> f <br /> ,Hardpan C] Adobe-fl Fi11"M4 <br /> terial ............ If yes,tyRe ' <br /> (Plat plan, showing size of lot, location of system in relation to wells, 'buildings, ete must be placed an reverse side.) <br /> NEW INSTALLATION: INo septic.tank or seepage pit permitted if-public sower its available within 200 feet,) <br /> PACKAGE TREATMENT [ I SEPTIC-TANK i 3 Siae_._...:. .d i ...........' <br /> Liquid Depth <br /> _ f(�.UO. -.. <br /> Capacity ype .::(�.�� ..: Materlal:.�. - ...... No. Compartments ............. <br /> y - <br /> Distance to nearest: Welt �7-,Q_------ <br /> . ------ ®*..:..__.:�.:�:"`Foundatian ...,er.C7:�`_..._._ Prap. Line _ q l <br /> �..--•--•-- J <br /> LEACHING LINE No. of Lines <br /> [ 3 -- -•---- Length of each line_.._°.®..............•. Total Length +.. �1 <br /> 'D' Brox � <br /> Fype`Filter Material . ._1 _ epth Filter Material y r <br /> i <br /> ............. ......... <br /> eta` Foundation �f <br /> Distance to nearest: Well Foundation E!1.._•---....__---- Property Line .---•-• <br /> SEEPAGE PITDepth .... Diameter• -_- .......... Number .............:.............. Rock Filled Yes Na {] � <br /> Water Table-Depth <br /> ....Rock S€ze •-----------------••---- 3 <br /> Distance to nearest: Well ................................. <br /> :....MFoundation ....... Prop. line ......_.._ ....... <br /> REPAIR/ADDITION#Prev. Sanitation Permit Date <br /> { <br /> Septic Tank [Specify Requirements) _....._ ................... <br /> Disposal Field (Specify{Requirements) <br /> .,� .............................. .... l <br /> ------------------•---------------- <br /> •-.----------•• ____ <br /> IDeaw existing and required dddition on.reverse side) <br /> 1 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 theSan Joaquin Local Health,_District. Horse owner or ficen- <br /> sed agents.signature certifies the following: <br /> "I certify tha in the performance of work for which this permit is issued, 1 shall not employ any person in such manner I <br /> as to becpmmgsubject to arkman' C mpensatIon taws of California." <br /> -- <br /> _Signed -----,--•- Owner <br /> .-. .------ ------------------------ <br /> ------------------ • ••- <br /> By ......... ---- -- -- Tine ~ . <br /> ---- ---- --------------------------------other n ow <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -------- <br /> - -. <br /> . ...... ...... ............. <br /> -- <br /> . .• <br /> BUILDING PERMIT ISSUED _-• --------. --*-------------------------------------- - --- <br /> ADDITIONAL COMMENTS ...._._.--•----•---- . DATE .... <br /> ---------------•----..-----...-•---------.-..----••......._...... <br /> -- <br /> ---------------------------------- -------------­----­- <br /> ---- ---- <br /> -- <br /> ............ .................................................. <br /> .... •-------•-•-. ---•--------•-----. <br /> Final Inspection by: .. -- <br /> EH 13 2a <br /> ...........................-_.. <br /> pate -- <br /> 1-6Y• SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 3M �` <br />