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FOR OFFICE USE: <br /> FOIR-SANITATION PERMIT <br /> -------------- <br /> =16---/L. _"- <br /> (Complete in Triplicate) Permit No. 7 <br /> ---------- ----- ---------------------------------------- <br /> -7 <br /> ----------------------------------_--- 40- This Permit Expires 1 Year From Date Issued Date Issued .. .... <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 existingAules and Regulations: <br /> JOB ADDRESS/LOCATI VOL A4f!�------CENSUS TRACT -------------------------- <br /> ---------------- -PAone ---- <br /> Owner's Name ------- ------------------------ ------ <br /> Address ------------------------- -- ---6.0 ---------- City -------a!t;;U-------------------------------------- <br /> Contractor's Name _b_A1yf___P;,1� -----------License # ------- ------------ --- Phone <br /> Installation will serve.. Residence 1p<partment House E] Commercial :F­lTrailer Court ',E] <br /> Motel F­l Other -------------------------------------------- <br /> Number of living units ...../... . Number of bedrooms ________Garbage Grinder ------------ Lot Size .... ---------- <br /> Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand'o Silt E] Clay E] Peat 0 Sandy Loam -E] Clay Loa MK <br /> Hardpan F] Adobe-7 Fill Material ------------ 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 /> ,p <br /> NEW INSTALLATION- fNo 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 ------.--__,;V ------ <br /> . I VLt <br /> Distance to nearest: Well -------------------------------------Foundation ---------------------- Prop. Line ---------------------- "IN <br /> ��No <br /> LEACHiNG LINE- of Lines Length of each tine------ --- ---------------- Total Length .___-__----.---._____._____- <br /> 'D' Box Type Filter Material ---------- Depth Filteri Material -------------------------------------------- <br /> Dist6nce to nearest: Well - ------- ----------- F66nda�tion ------- ----------. Property Line ............­---------- <br /> SEEPAGE PIT <br /> Depth ----- --- --- Diameter __! ------------ Number ----------------- ---------- Rock Filled Yes E] No 0 <br /> t a 2; <br /> WaterTable Depth ----------------------I--------------------------Rock Size ----t--------------------------- <br /> Distance to nearest: Well --------------I----------------------_-Foundation .......... --------- Prop!Line ___I_____--__-_--____ q <br /> l REPAIR/ADDITION <br /> --I----------------- <br /> REPAIR/ADDITICIN(Prev. Sanitation Permit# -------------------------------------------- Date ---------------:------------------) J)N <br /> SepticTank (Specify Requirements) ---------------------------------------------------------------------- -- ------------ --------------------------- <br /> -- _Q,Disposal Field (Specify Requ ements) -----14 ----QA4 __ --- ---- <br /> ------------------------------------ <br /> ------------ ----- -------------------------------- -- ----------------------- --------------------------- <br /> - <br /> ------------------------------------------- ------------------ ------------ ------------------------ ---------------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have 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 issuedr I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed - - -- ---------------- --- - -----)----------------------------------------------------- Owner <br /> By ...... -- A --------- - ---- ------ --- Titlee ----------- -------------------------------------------------------------- <br /> (if oth t an owner) <br /> ��ilf�O4� �at --F-OR--D-EPARTMENT USE ONLY <br /> I _TAPPLICATION ACCEPTED BY ------ _04IN-LU--------------------------------------------------- --------� DATE J_[ ff------------------- <br /> BUILDINGPERMIT ISSUED ------------------------------------------------------------------------------------------- -------------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS ---------------------------------------------------------------__--------------------------------------------------- ----------------------------------------- <br /> -------------------- <br /> ---------------- ------------------------------------------------------------------------- ----------------------------- --------------------------------------------------------------------------- <br /> ---- -------------------------------------------------------------------------------------------- ------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------- ------- <br /> ----------------------- <br /> FinalInspection by: ----------------- ------------J --------------------------------------------------------------------------Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'66 Rev. 5M. <br />