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o <br /> FOR OFFICE USE: FOR OFFICE USE: <br /> .. <br /> -, APPLICATION FOR SANITATION PERMIT <br /> -------------------------- --------------- - <br /> (Complete in Triplicate) Permit No. 7 <br /> This Permit Expires 1 Year From Date Issued Date Issued__: :_ 7V <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: <br /> JOS ADDRESS/LOCATION------------------J �� - -- �------ ------- CE ACT--------------------------------- <br /> �=-- -------- : IVSUSR <br /> # ,�. ti iw...� - <br /> v ti <br /> Owners Name 1 --'----- � ---------------------=-------------------------------------- -------- -------------Phone-------------------------------------- <br /> Address-------------- �k 6 � - -'i7---- - --- - - --- ---- ----- ------------------Ci _.-_P <br /> —--- -----Zi ----- <br /> Contractor's Name-E ,,__Lt. Ll(� -...--------------------------------------License #- /_6_�._--Phone_ c _ <br /> Installation will serve: Residence- Apamment House7E— --Commercial ❑ Trailer Court+ <br /> Number of living u ` '_. . ... Motel F1 Other- T I e' <br /> w_ <br /> its:__:.I_________Number of. bedrooms.,..--_---Garbage Grinder------------Lot Size -- _ <br /> .-- ._.__ _ <br /> _________ ____ <br /> {{ <br /> Water Supply: Public System and name-,--f-.,- &4/` -------------------- 4 ------- ---- -- --- I-- -I,--- --------------------Private E] . <br /> ~s til ` <br /> r Character of soil to a depth of 3 feet:. Sand ❑ Silt❑ Clay ❑ Peat❑#r Sandy Loam JX Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material-- — yes, type-_--____________ _____ <br /> _ ______) <br /> R F � } <br /> (Piot 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 '.r seepage pit permitted if public sewer is available withi 1200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK -Li u <br /> [ ] [ ] : Size--- ---- ----- � - ---- --- - - q id <br /> G i , . --- I j <br /> Depth--------------------------- <br /> Capacity <br /> - ----------------------- <br /> Ca acitY == Type Material = No. Comparerts_ �-M- -DistanceW _------- ------------------__ oundation.__--- ------ ---Prop. <br /> Line---------------------------. <br /> I LEACHING LINE:. [ ] No. of Lines,:---------------------------:Length of each line-------_----_.-_-------:-----Total Length.--------------------------------------- <br /> D'B _ Type Filter Material--------------------Depth Filter Material-------------------. ----.----------------------------- --. <br />�. Distance t�_rseare'st: Well----------------------------Foundation_________________y_--_ ._..Property Line._-----_--------------- <br /> - <br /> SEEPAGE PIT [ ] epth.--- ------ 'Diameter____________________Number_.__________._ I_--�_____ ) Rock,Filled Yes L] No❑ <br /> 1 Water Table Depth ---- -- --- ------- RocksS;zer <br /> 1 0-------------------- <br /> Distane�to nearest: Well---------------------------------- ------Fouridtitian�.------- ------ --- _.Prop. Line---- ---------- <br /> REPAIR/ADDITION (Prey. Sanitation <br />` f <br /> Permit#----------------------------- = _ ------------ <br /> "----------1Dated. _ __-_-_---___-_-_-_--_---.-_--..--E_.�........ <br /> ___,___ <br /> uernents)Septic Tank [S ecif Re -------- --- ------------------- ---------------------------------�- ----------}- <br /> -_-_-- <br /> --------- <br /> Disposal Field (S efReg u ma- <br /> re - -- <br /> ""'�.,��•1'^ <br /> ----- -------- <br /> -------------------------- <br /> -------------------------------t----------- = } ------------------------------------------------------------ , <br /> ------------------------------------------ � <br /> ES` (Draw existing and required addition on reverse side) z <br /> I hereby certify that l have prep red this application and that the work will be done in accordance with San Joaquin County <br /> Ordinances, State Laws, and Mules and Regulations of the San Joaquin Local Health District, Horne owner or licensed agents <br /> signature certifies the following: <br /> i <br /> "I certify that in the perforrr6n�ce of the work for which'this permit is issued, I shall not employ any person in such manner as <br /> to become subject t a man's Compensation laws of California." v ... <br /> : <br /> - - t <br /> Signed. v- - ---- --- <br /> ---Owner <br /> ----- - -- - <br /> gY---------------------------------------------------=`'� -------------------------------------.----- ---- Title------------:--- -- ------.-- --- ----------- ------------------ <br /> _ -------------- r <br /> Of other'jhan_o.ner. ; <br /> F61—DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED B = _- ---` - ----------------e------------------------------------------DATE----- -- - - <br /> f DIVISION OF LAND NUMBER ------''i-- _�: _. --- DATE.!-. _ <br /> y._ _ <br /> ADDITIONALCOMMENTS--------------- -------------------------------_-_1--------f ----- _ w--------------------------------------- ---------------------------=-------- <br /> == --------------- ------------------------ <br /> - -- -- --- _ . <br /> i Final Inspection by------------ ------ -- - flit T <br /> '- --------------------- = = Date =� <br /> EH 13 24 SAN JOAQUI.N LOCAL HEALTH DISTRICT F&5 216776 inn <br />