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fFOR OFFICE USE- <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PER 7�� <br /> ------------------------------------ ------------------ Permit No <br /> 7! <br /> (Complete in Triplicate) <br /> �w.-- 7 f <br /> �. <br /> Date issued.-----`-----'�._-_-- <br /> ----------- This Permit Exp"iies 1 Year From Date Issued !l <br /> � II <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 Ordin nce No. 549 and existing Rules- nd•Re ulations: <br /> . - . .... "l SUS. <br /> 'JOB ADDRESS/LOCATION-;.�-, = TRACT "� 7.� <br /> � � } <br /> Owner's Name_.IhL_ :--.I� - - Phone <br /> Address ��lf ms' s `-- ---------------------City Zi ---------- <br /> Contractor's Name---- .-:-- .................... -----------=License #-e - �.`�' Phone <br /> Installation will serve: ? Residence. Apartment House❑ Commercial F] Trailer Court ❑ <br /> 1 .-. Motel ❑ Other-------- =- -------------------- ----------- � !1. <br /> Number of living units:.-: ------Number of bedrooms.'-�----Garbage Grinder------------Lot Size-.�._-4______________�-— . ------- ' <br /> Water Supply: Public System and name----------- --------------------------------------------- ----- = ------------- ----------------- <br /> Private <br /> ------------. Private i <br /> :._.-_ <br /> Character of soil to a depth of 3 feet: Sand E] 'Silt Ll Clay El Peat E] Sandy Loam ❑ Clay Loam ❑ _ I� <br /> Hardpan [I Adobe X, Fill Material- <br /> . -_----.- <br /> 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,) of <br /> 0 <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [W • Size-- ._f -- _rn -- ----- --------------------------Liquid Depth----------- ----------,---- <br /> D [?---- YPT e -Xe- <br /> Material_1.�_OC Cn ..........No. Compartments-----------�'M--------------m <br /> Capacity/;? -:- <br /> fi Distance to nearest: Well----/6-4--- .-------------------=--=Foundation/Q--------.--------Prop. Line- --------------- <br /> LEACHING <br /> :- ----------LEACHING LINE [yam No. of Lines--------�-------------- Length of each lina_k-S_�-- ' ----------Total Lenq�th.,.--/70--------�---------------M <br /> D' Box-.-/-- ---Type Filter Material 6/RA�-/L'-Depth Filter Material__ _- w t - <br /> --•- -- <br /> to nearest: Well__- � --------------Foundation.-_ -- --------------Property Line__--_ ---------------- <br /> Distance;. .. I <br />! -_- - � <br /> No <br /> SEEPAGE PIT Depth........ --Diameter----3-j._ -----Number---_-- --_______---------- RockFilled Yes <br /> _ __Water­Tabie Depth.-- --e -- -- ------ ---Rockize-- <br /> Distanceto nearest: Well - : --- Fou a --.---. Prop. Line -__�-` ----` <br /> -- <br /> i REPAIR/ADDITION (Prev. Sanitation Permit#-------------- `----------- :-------------i-----Date-------------=----------------------------------- <br /> ----------- <br /> ----- ---- ! <br /> Septic Tank (Specify Requirements)--------------- -- ----- _ <br />[ - ------- <br /> - ----- --------------------- ------------- -, <br /> Disposal Field (Specify Requirementsf--�-- ---------- - ------- ---------------------- ------------------- --;;--------------- - <br /> ----- ------------- ------- -- ----- ----- --- = ---- " <br /> ---------------------- ----------- ------ ----- <br /> --------- <br /> � i <br /> = <br /> - ----------------=---r - <br /> (Draw existing and required addition on reverse side( <br /> i I herebycertify that 1 have repared this application and that.the work will be done in accordance with San Joaquin Coun <br /> fY P <br /> Ordinances, State Laws, and Rules-and Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: 4 <br /> 4 <br /> "I certify that in the performance of the work for which this peimit is issued, I shall not employ any person in suchmanner as <br /> to becomes ject to man' CompensVtion laws .of California." <br /> Y 1 r <br /> Signed - �s A t-= - . <br /> -- Owner <br /> ., <br /> i t. ..-� , <br /> sY; = j Title-- �' ------"-------------------- --------- - <br /> I <br /> (. !I <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY I. <br /> ;. <br /> ---------------- <br /> APPLICATION ACCEPTED BY----- <br /> ---------- - ` `- -" <br /> + DIVISION OF LAND NUMBER. -.. - --------- -----DATE--------E--------------------: -------------- <br /> ' ADDITIONAL COMMENTS = :/C® ��-; l --Z ------1 Z.----- I-------------- ------------------I------- <br /> "-` <br /> --------------- ---------- -------------------------------------------------------- <br /> --------- -- - ---- ----------------------- <br /> --------------- <br /> -------------------- <br /> -------------------------------- .11 <br /> -- <br /> -/ <br /> - -------- <br /> ------------------------------------------- <br /> -------- - - <br /> ------------------------------------------------------- ---------- - ---------- - <br /> Final Inspection b -------------------------------Date----- s - = = <br /> fH 13 24 SA JOAQUIN LOCAL HEALTH DISTRICT F85 21677 REQ 76 3M <br />