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FOR OFFICE E: <br /> __ APPLICATION FOR SANITATION PERMIT ��7 <br /> ..........` Permit No. 7 ' <br /> "1 ----- <br /> c!11- ------------------------------------------ {Complete in Triplicate) <br /> -------- ---------------------------------------------- <br /> Date Issued <br /> This Permit Expires 1 Year Froi011)ate Issued <br /> Application is hereby made,the,Sdn-Joaquin Local Health District'for•a permit to construct and install the work herein <br /> described. This application�*s made inl'compliance with County rdinan .e No". 549 arid existing Rules and Regulations: <br /> JOB ADDRESS/,LO ION (�{ l CENSUS TRACT --------------------•---- <br /> Owners, NarAA - ' -------------- ------------- ---Phone ------------------------------------ <br /> Address __ � --------- at ttf lrl <br /> F ---------------------------.License # � <br /> Contractor's`Nam'e __#�,�p��-- _C�� _ �� -_X►► _. __0hone <br /> Installation willecve: { Residence Apartment House-[:] Commercial:❑Trailer oust i❑ <br /> Motbl�❑Other ------_-------------------------------- <br /> 10-4 � V► t f <br /> Number of living -units _ -- ___ Num ,of bedrooms ___Garbage Grinder e ,/-- <br /> p_ Lotsize - _ _zp......... <br /> Water Supply: Public SystZlahclnam 'il =- ---- ------------- <br /> ____ __.Private El� _ ,` rp <br /> - <br /> Character of soil to a dept of#3#eet: `Sa d'I-1 S IS ,`Clay ❑ Peat❑ Sandy Loam�� ❑ Clay Loam ❑ <br /> F1 Hardpan[� A�dleFill Material _ If yes,ty�____________________________ <br /> (Plot plan, showing size of lot, locgt n oUsystem in relation to wells, buildings, .etc. mut be placed on reverse side.] <br /> NEW INSTALLATION: (No septic tank orseepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK{ ] Size------------------------------------------------- Liquid Depth --------------------,----- <br /> 1 Capacity TYPe -- ----------------- Material---------------------- No. Compartments ...................... <br /> Distance to nearest: Well --- --------------------------------Foundation ____.____._________--_ Prop. Line ____.___..___--_.____. <br /> LEACHING LINE [ ] No. of Lines ________________________ ?Length of each line---------------------------- Total Length -----------.___________-____ <br /> k <br /> 'D• Box -17_-.-_____ Type Filter Material DepthtFilter Material ------------------------------------ <br /> x r <br /> Distance to nearest: Well _____ _________________ Foundation __'______________-_.-- Property Line -----.__._._____., -..__ <br /> SEEPAGE PIT [ ] Depth ----�_.___-_________ Diameter --------i------ Number .------- Rock Filled Yes ❑ NL�o <br /> Water Table Depth ---------------I--------- -------------------Rock Size --------------------------------Distance yir <br /> o nearest: Well_- = :______— -------------------Foundation _ _.Prop. Line ___._ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------_---------_----,_--__ Date _A__________________�/AA � <br /> Septic Tank (Specify Re -- ----`----- ---� �' ---� -- =-� 1� <br /> Dis�asa! Field (Specify Requirements) /� -_�-- 2 _ - <br /> ' m 6" { = �. <br /> ---�=-� - .--sib= -��/�------ > ---- --- r - - 'r' - �'"!�� -----•� �- <br /> ----------------------------------------:--------------------------------------------- -------------------- <br /> (Draw existing and.required addition on reverse side) <br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, c;nd Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following , <br /> "1 certify that in the perform nce f the work for whichYhis permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's CompenWoniaof California' <br /> 1 , <br /> Signed -------------------------- --------- ------------------ - Owner <br /> By ------------- --------------------- t Title-- w -.�------- <br /> (If other t o ner] V <br /> FOR DEPARTMENT USE ONLY <br />' UI <br /> ,APPLICATION ACCEPTED BYil DATE 1a.- - 1 <br /> BUILDING PERMIT I55UED "r---------------- <br /> ------------- DATE --------------------------- -----------•- - <br /> AD,DITIONAL COMMENTS ------ ----'-------------'"� '' --'---------- <br /> a4o �� ---------------------------- <br /> 3C -lo ---1�--- <br /> ----------------------------------- --- - -- - - -------------------------------------------------------------------------------------------------------------- --- - <br /> Final Inspection b - - �` <br /> p Y� --- ---------------------�----------------------------- -- ---------------- ---------------.Date --- -�-��--------�-------------------- <br /> 1. <br /> SAN' JOAQUIN LOCAL.i HEALTH DISTRICT <br />' E. H. 9 1-'6$ Rev. 5M <br />