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FOR OFFICE USE: FOR OFFICE USt:: <br /> APPLICATION FOR SANITATION PERMIT qq <br /> ------------ ------------------- . --..... Permit <br /> --------------- -- - •---------... (Complete in:Triplicate} ; <br /> -------------•- -• <br /> • Date lssued7.-1.:--^--• -- <br /> -•••--- ------------------------------------------------ This Permit Expires ] Year From Date Issued <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 Ordinance No. 549 and existing Rules and Regulations: ri <br /> -..-.CENSUS TRACT..---- <br /> JOB ADDRESS/LOCATION.....- -7 T.-1.....Ffr--.� _.-mol -. -... _.. <br /> F3�--22�-� .. <br /> Owner's Name.... .__ Ph we.. <br /> Z i <br /> - /}`Nl ..-.. ........ ---- ---- City - "..-- ------ _-Zip_:-------- <br /> Address-.,-. <br /> ��A.... ...... ---------------------_.... - ----- <br /> Installation will serve: Residence ❑ Apartment use ❑ Com ercial Trailer Court El. - <br /> Motel ❑ er- � � - <br /> Number of living units:.................Number of bedrooms-. .-. Garbage Grinder------------Lot Size............... ..... .. . ---- -------- <br /> Water Supply: Public System and name............. ------------.___.Private ❑ <br /> Character of soil to a depth of 3 feet: Sand El Silt E3 Clay ❑ Peat E] Sandy Loa? 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 INSTAL;ATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> _ -- .'Liquid Depth------------- ---- � � <br /> PACKAGE TREATMENT ( ] SEPTIC TANK`( "] I�- L-e q <br /> Size..... �-.- ------ -•--------- ... - - - <br /> o. Com artments.,-;-.;... <br /> Capacity-/ O. YPe �i 4Material..- �1. ..16 P <br /> . <br /> Distance to nearest: Well.:_---------- -- - - ---- -------- -Foundation--- ..-- --. <br /> --• ......Prop. Line..------ -- - <br /> f <br /> -r <br /> --- <br /> ar line - 7 - Total Length ---- .--- <br /> iv <br /> LEACHING LINE �j No.`of Lines -_---------i-'---Length o.f..e <br /> 'D' 3ox_.../. ...7ype Filter Materialr_2Dp terMtefrial - -----e--5�,r------ - ----------- <br /> - ------ <br /> /�----- -... <br /> ---- <br /> / l '-� . - oun ❑tion----- l Property Line...- r <br /> Distance to nearest: Well <br /> SEEPAGE PIT [ ] Depth_._. .. ...Diameter---------=-----.----Number ----------------------- -- ---- <br /> Rock Filled Yes El No <br /> Water Table Depth--------------------------- -•---- Rack Size <br /> _4 ... --- ----..Foundation................ .- <br /> .......Prop. Line..---- --------- .._... <br /> Distance to nearest: Wel{................. <br /> REPAIR/ADDITION (Prev. Sanitation Permit#------------ ---__------- ------- ..---.Date ------- ----- --- ------ <br /> Septic Tank (Specify Requirements)--------- -- ---------- ------- --------------------- ------------ ----- ----------------- - - ----- -------- <br /> Disposal Field (Specify Requirements) G ---+-----�►-~---...._-7� Of <br /> / <br /> l r <br /> I --------------------------- ------------ ------------- --------- <br /> (Draw existing and required addition on reverse side) <br /> i <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> i Ordinances, Stag Laws, .and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents <br /> 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 as <br /> to 5i` came sub' t to rorkman'sCompensation laws of Califon Owner k <br /> g .nefir` <br /> I � <br /> : . <br /> (If-other, than owner( <br /> FOR DEPARTMENT USE ONLY t' <br /> APPLICATION ACCEPTED BY----- ..-- -DATE --- '. - <br /> DIVISION OF..LAND•NUMBER-------------------------------------------- -- <br /> :...` ...DATE-7.......... ....... ...... <br /> ADDITIONAL COMMENTS'.':'.'-....- ......•- --------- <br /> ----------- <br /> ------- .,.. <br /> ..... <br /> .... -- <br /> . ...... ...... ............... <br /> ------------------------ --------- - - ------------- --------- •--•---- -- -------- ---.....---- -..- - ----- - ........ <br /> ..-----------•� -- - ------------- ---------------- <br /> Final Inspecfion b ----- ...Dat _... �..._.-. 1677 REV. 7/76 3M <br /> EH 13 24 SAN JOAQUIN L CAL HEALTH DISTRICT �s a <br />