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-FOR OFFICE USE: FOR OFFICE USE:
<br /> APPLICATION FOR SANITATION PERMIT
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<br /> (Complete in Tr plicate) Permit No..7.7-"--3�_7
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<br /> i IDate Issued..-'.�.",X-,�' 7-?
<br /> -------------------------------------------------- This Permit Expires 1 Year From Date Issued
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<br /> Application is hereby made to the San Joaquin Local Health Distr,Aict 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: v ,
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<br /> JOB ADDRESS/LOCA ON---- 7 ! �-'- =-.- .,---.CENSUS TRACT-...__.-.- F-.-.
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<br /> Owner's Name-•----- :.. . ---- Ph _
<br /> :. one
<br /> Address - ---------- .} -- -------- . Zi ����3
<br /> Q• � l-� Ci
<br /> _ ty p- ---
<br /> r. , rla;11,1� . �-- _Lice Contractor's Name----- --' . ' 'r— ----- nse # SY:. Phone `..)
<br /> Installation,wilFserve: Residence ❑ Apartment House - -/�C,om'mercial ❑ Trailer Court ❑
<br /> • Motel L] Other = ��'-9J�c� ' 4 '
<br /> Number of living.units_--------- ______Number of bedrooms-------!.---Garbage GrindLr_ -----,-:`._Lot;Size--- ----------- ---------------.:-- ---
<br /> Water Supply: Public System and name :--= ---- --- -----. € ------- ---- ' ``-- ----- ----- ----- ------Pr
<br /> ivate�
<br /> Character of soil to a depth of 3_feet. Sand ❑ Silt E],} Clay, ❑.4._,/ #
<br /> Peat❑ ',Sandy Loam❑..,,,kClay_Loam
<br /> Hardpan ❑ Adobe ❑ Fill Material_ /-.-"-If yes, type.. ---- ----"----- -- ------ j
<br /> (Plot plan, showing size of lot, location of system inkelatio� to wells, buildings, etc. must be:. 1iced;,on, reverse side.] r r
<br /> NEW INSTALLATION: ]No septic tank or seepage pi 1p'erm.itted if public sewer is available within 200 feet,) .,.5
<br /> PACKAGE TREATMENT ( ] SEPTIC TANK '('] Size ---. - --_-; _ - :'__Liquid-Depth .----- ------i. -
<br /> } No:-Co' partments--- - _. -:
<br /> ' M
<br /> --------
<br /> Capacity--- �... ='___...}Type_ . ateryal=_ a ------ a
<br /> t Distance'to nearest:.Weld�- ------------ ----- Foundation--'- ' ------Prop. Lino-------- ----------------f
<br /> LI ` - Len -th of line----- i=, 1 :Totai�Len th. --------- --------------
<br /> LEACHING LINE. ( ] N'o. of'Lines -----;---. g g
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<br /> D Box ----------Type Filter Material —fi- Depth Filter Material----------------------------- -- 2
<br /> > t .� ..!�T n T ., Property-Line -
<br /> .Distance.,=tv-nearest: Well --- Foundation - --
<br /> -SEEPAGE-PIT, [ ] Depth=� F� __- :Aram ter- -------------------Number_-------------.--------------_ � Rock Filledr Yes ❑ No [�
<br /> Water Table^-Depth. �-- -_--"-
<br /> f ,.. -------------------------- Rock Siz .,_ -------- ------------- --- ----;-- .
<br /> } �tA � f s i
<br /> Distance.to nearest: Well--::-------- ------------- ---- Foundation.- _---:------'--- Prop..Line-------------------------
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<br /> REPAIR/ADDITION
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<br /> REPAIR/ADDITION (Prev. Sanitation Permit# 7---: " - -
<br /> • .Date '- �.
<br /> Septic Tank (Specify Requirements) "" -- i ---------- --- -- ----- --------- --------
<br /> , lo) " �; ! '; S_a -- - ----- -----------------------
<br /> ---------
<br /> Disposal Field (Specify Requirements);.._ : _------ -- -- --_-- -- --------------
<br /> =
<br /> , ,a,,.+., •.r-,.!- -r-w-.+ .. - ------------------------ ---- --------- .
<br /> -------------------------- ----------------------'---_--- ----
<br />�' ---'- `-'---•---."`-"--------------------------------' ---------------------------_------ --- ..--.-. ---- _--------------
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<br /> (Draw existing and required addition.on reverse side)
<br /> I hereby certify that I-hcve pr`epared'this application-arid that-the-work-will-be--done'min-accordance•-witb-San Joaquin County
<br /> Ordinances, State Laws, and Rules and Regulations, .oV the: San Joaquin Local Health District, Home owner or licensed agents
<br /> signature certifies the following:
<br /> "I certify,that in the performance-of the'work for which thi ep emit is issued, Ishall not employ any person in such manner as
<br /> to become subject to.Workman's Compensation;,.laws of California.'... . . .. �
<br /> Signed- -- Owner
<br /> Ow
<br /> c.
<br /> g I - Title I
<br /> Y �F' -
<br /> 7i �t than :owner) v
<br /> s FOR DEPARTMENT USE ONLY
<br /> APPLICATION ACCEPTED BY------�'-------- ------------------- -----------=---------------- --`------ ......--- DATE.-.: Za --------------------
<br /> DIVISIONOF LAND NUMBER.------ = ---------------- -------------------------- --------------------DATE-------------------- ---- --
<br /> ADDITIONALCOMMENTS--------_-- ----- --------- ------------------------- -------------------------------------------- ----------------=-----------
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<br /> Final Ins ection b - -----------------Date__- - "_ .- .-
<br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 REV. 776 inn
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