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FCR OFFICE USE: <br /> APPLICATION FOR_,SANITATION PERMIT <br /> ------------ <br /> ;. (Complete in Triplicate) Permit No: 7 <br /> ------------------ --------------- This Permit Expires 1 Year From Date Issued Date Issued ---57_Z:_/,(-_.7 i <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 /> 9 <br /> JOB 'ADDRESS/LOCATION . �1I#7-1 ----- � c ------..CENSUS TRACT ------------- <br /> Owner's Name ------- ------- �`�, r L7 ' ��'t� --------------------------------- Phone;n06_'_-d ii/ <br /> Address ----- -- ------- -- 1----- -- Cr City -_-------------------------- <br /> Contractor's Name ... - -- _ --t?-�!_ _�.._a+License # _� f-(------ Phone7__`--•- <br /> - ---------------- --- <br /> installation will serve. U Residence KA artment Hous p ❑ Commercial ❑Trailer Court ;❑ <br /> Motel E]Other <br /> Number of living=units:--- <br /> Num �__ Number of bedrooms - ----- ------------ --------------- <br /> _- <br /> - <br /> Garbage Grinder _-__ - Lot Size _-_ �✓_6--------- <br /> Water <br /> r <br /> Water Supply: Public System and -------------- <br /> name -_ ---------------------------------' _`________--Private ❑ <br /> I ------------ <br /> Character of soil to a-depth of 3 feet, SandE] Silt❑ Clay ❑ Peat ❑ Sandy Loam .❑ Clay Loam,0 <br /> Hardpan ❑ Adobe 1% Fill Material ------------ If 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,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK. ] Size____________________________________------------------------------------------------- Liquid Depth -_______---_-________-._. <br /> Capacity ------------------ Type -------------------- Material------------- -------- No. Compartments -----------......_. <br /> Distance to nearest: Well ------ ` <br /> -----------------------------f=oundation ----------- ------ Prop. Line -------------------... <br /> LEACHING LINE <br /> '3 [ ] No. of Lines ------------------------ Length of each line-------------------'..------ Total Length ,___-_.__- . <br /> t 'D'-,Box_:__-____-,_,.Type_Filter Material ------------------..Depth Filter Material ----_.___--_-___ <br /> Distance to nearest:-Wel.l-------------- ---------- Foundation ------------r----------- Property Line ------------------------ <br /> SEEPAGE <br /> ---------------__ __ __SEEPAGE PITt <br /> [ J Depth ......... ---------- Diameter --------------- Number ____________________________ Rock Filled Yes ❑ No SCJ ' <br /> I i <br /> Water Table,Depth ------------- ---------------------------Rock Size ----i <br /> Distance to nearest: Well ------------t---------------------------Foundation --------------------- Prop. Line ---------------_---- <br /> REPAIR/ADDITION(Prev. Sanitation Permit#.:__-_-___.__---------i------------------------ Date _____________- <br /> Septic Tank (Specify Requirements) ,_ __-. _ } <br /> Disposal Field [Specify Requirements) -______- --___--_-_ -----_ -- , <br /> ------------------ <br /> rf <br /> ------------------r----- ----------------------------- ------------------- 3------X Z j <br /> i ---------------- ------------------------------------- --------------------- <br /> t _(Draw existing and required addition on reverse side) <br /> I hereby certify that I'6ave'prepared this application and that the work will be done in accordance with Son 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 performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become subject to Workman's'.Compensation laws of California." <br /> i - <br /> Signed ----------------------- -- Owner <br /> --- - ------------------------------------ <br /> Sy -------- -------- ----- (---- - Title <br /> ----------------------------------------- <br /> {lf ather,t a owner) ky—A - <br /> FOR DEPARTMENT USE ONLY 4 Of <br /> APPLICATION ACCEPTED BY __________ <br /> ----------- DATE ` <br /> BUILDING PERMIT ISSUED.. = = DATE <br /> - --•--- <br /> NAL COMMENTS ---------------- <br /> -----------------------------------------------------------------------------••------- <br /> 1 ------------------- <br /> ------------------------------------ _ z <br /> Final Inspection by: .- ._-- ---. -- --- Date �r <br /> SAN JOAQUIN LOCAL HEALTH DISTRIC <br /> E. H. 9 1-'68 Rev. 5M <br />