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1;9 <br /> F OFFICE USE: APPLICATION FOR SANITATION PERMIT a "' <br /> n ---------------------- '~ } <br /> Permit No. 7 <br /> (Complete in Triplicate) � <br /> ------ ---I----------------------------- <br /> Date Issued -3:x'1 <br /> ---_----------------------------------_--------------- This Permit Expires 1 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 <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> �f 0335• --- - - - -------------- <br /> , <br /> JOB ADDRESS/LOCATION .�" _ S-- - -- <br /> ---------------- - - CENSUS TRACT ?ted _-3AB-"p� <br /> Owner's Name ------- _?-1 W Phone _1�_� '7 S <br /> Address - - --- ---------- =f. .s G`_-- c ---------------- City ----------------------- --------•----------------------------••------ ------ <br /> Contractor's Name ------------------------ ----------License # ------------------------ Phone -------------------- ........ O <br /> Installation will serve: Residence [R<partment House❑ Commercial:❑Trailer Court ',❑ <br /> Motel ❑ Other -------------------------------------------- t j <br /> Number of living units:-.--/------ Number of bedrooms --_- __--Garbage Grinder --7n.--- tot Size -----ZA------------------------------ <br /> Water Supply: Public System and name ----------------------------------------------------------------------------------------• ....................Private-� <br /> Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat ❑ Sandy Loam •❑ Clay Loam ❑ T <br /> Hardpan ❑ Adobe-( ill Material ------------ If yes,type ---------------------------- <br /> (Pilot <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------I Liquid Depth -7 ________________ <br /> Capacity Jd&0---------_ Type I9.�,Cras�------- Material _-- --. No. Compartments ----- -------- - - <br /> Distance to nearest: Well -----------/ice-----------------Foundation ------16---------- Prop- Line --------. <br /> LEACHING LINE [ ] No. of Lines ------3--------------- Length of each line-------q0--------------- Total Length __a7.��-.-____--___._ <br /> 'D' Box 7iM----- Type Filter Material Sep.-t�--_--.Depth Filter Material ......a!'-------------------------- <br /> Distance to nearest: Well ----- es.)---------- Foundation ------10------------ Property line --_6---_-._---- t <br /> SEEPAGE PIT [ ) Depth ------------- ----------_ Rock Filled Yes No C.------- Diameter ----- ----•---- Number ----- - - ❑ � <br /> Water Table Depth --------------------------------------- --------Rock Size ----------------------------•--- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---.------------------ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ---------------------------._-----) <br /> SepticTank {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 Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the perfo ce of the rk for which this permit is issued, I shall not employ any person in such manner <br /> as to k grcatnherrsub__jecct to or man's Co en at' n laws of California." <br /> Signed ------------------ Owner <br /> By -------------------------- Title ----------- ----------------------------------------- --------------- <br /> (lf other than owner) <br /> C1� <br /> FOR .DEPARTM T USE ONL g <br /> APPLICATION ACCEPTED BY ------------------------------------ ----------- -- --`--------. DATE ---(yL E_- _'f------------------- <br /> BUILDING PERMIT ISSUED ------------------------------------- ----------- --------------------- -------------------------------DATE ------------•---------------------------- <br /> ADDITIONALCOMMENTS -- -------------------------------- ---------- -------------------------------------------------- -------------------------------- --------------------------- <br /> ---------------------------------------------------------- ------ <br /> -------------------------------------------------------- --------------r-------------------- -------------------- ---------------------------- ---------- <br /> ------------- - --------------------------------------------------------------------------------------=------------ -----------------��// <br /> Final Inspection by- ------------------------------------------------------------------•---------------- �l Date "X- -7Y------------------ <br /> SAN JOAQUIN LOCAL�;°HEALTH RICT <br />�' <br /> E. H. 9 1-'68 Rev. 5M _ <br />