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V APPLICATION FOR SANITATION PERMIT <br /> .................. ...._.... <br />' (complete in Triplicate) Permit No. 7 - <br /> .... ........................................ .. P.... <br /> This Permit Expires 9 Year From Date Issued Dab issued : <br /> ....................I........ ._. .......... .: <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the wont herein <br /> described. This application is made in compll ce wi h County rdlnance No. 549 and existing Rules and Regulations: <br /> i ,/ <br /> JOB ADDRESS/LOCATION ..-- ©'�'`' <br /> --F_-----�(r f .�.L,...AM ..................CENSUS TRACT <br /> Owner's Name ._...--•-••- -- .... .. <br /> � I ...- one -.,ril . ... .. <br /> Xiddress h� <br /> --�� .....---•.................. <br /> r� .......... <br /> Contractor's Name - -- ..i... .?� -Q....... t r � <br /> •--- pa . .......................•-••-----•License � ....__.�....�.. Phone <br /> Installation will serves Residence[�A rtment House 0 Commercial❑Trailer Court ❑ <br /> } <br /> Motel ❑Other <br /> Number of living unitsr.....f..... Number of bedrooms ----��.1.....Garbage Grin r t Size <br /> Water Supply: Public System and name .................................--............._•-•-.. ry... }.. t. . <br /> n - .. ....Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ ndy loam ❑ day Loam <br /> Hardpan 0 Adobe D4.- Fill Mcterial ............ <br /> 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: lNo septic tank or seepage pit permitted If public sewer is available within 200 feet) <br /> PACKAGE TREATMENT I ) SEPTIC TANK f ] Size................................................ Liquid Depth a <br /> Capacity . ...............• Type ... .......i......... Material.._. ..... ... No. Compartments .....................�\; <br /> Distance to nearest: Well' Foundatio <br /> I ....y '. ............. �_ -.............._... Prop. Line .--- •---............ <br /> REACHING LINE [ ] No. of Lines ....__. ngth. of each Ilne....:.......... ... Total Length ............................ <br /> 'D' Sox .. Type Filter terial ................... <br /> Depth Fill r Material <br /> Distance to nearest: Well . . _... Foundation .......... ............. Property Line ........................ <br /> SEEPAGE PIT [ ] Depth .................... Diamet ..............:. Number .. Rock Filled Yes ❑ No.C] <br /> Water Table. Depths ........ : . .................................RockrSize ........................ <br /> Distance to'nearest: Well __: `:: ......................Foundatio :................. Prop. Line ...................... <br /> REPAIR/ADDITION(Prev.�Sanitation`Permit .........'.. ...................... ... Date <br /> Septic Tank (Specify Requirements) .......... .............. ................................. <br /> Disoosal Field (Specify Require: pts) .. �- .�....__._ _ - -----..-..�..... .......................................� ........-••...... <br /> ....................... .. ....=t72t -------f...... <br /> ...............................I..................... <br /> . ....... . ..I .. . ... <br /> ......... <br /> (Draw existitri9 and required addition on reverse side) <br /> I hereby certify that I have prepared this applicagon and that the work will be done in accordance with Son Joaquin <br /> County Ordinances, State Laws, aril! 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 t Workm%n's Compe .atlon laws of aiifornia. <br /> :.fined <br /> .......:...... ... ^ -.:-Q...`.r`... .........._.. . .... ... Owner <br /> .... .__...... <br /> $ a —a <br /> y . ... ................................ <br /> ._. ............................................... <br /> (if other than owner) <br /> �- FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY,..1..�- -0 - <br /> BUILDING PERMIT ISSUED DATE ..�."_.9''.� .:...........:. <br /> .. <br /> - ...°....:.-_DATE-:-.-...........:.... <br /> ADDITIONAL COMMENT5 ........ .......:..-----*............... <br /> - - .. . ._ - ............... <br /> I€ <br /> . ,i.-_- <br /> ............ . <br /> ...... . ...... ........................... ------ <br /> ................ ..._. <br /> 1­1 <br /> - - <br /> ... ......... . .............. ---- •-----...__...--- .......... <br /> Final Inspection by: _...•.---- _. .......Date .. ... � <br /> Eli 13 2L 1-68 Rev. $5l <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 6/7h 3M <br />