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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT , <br /> Permit No. _7 I <br /> (Complete in Triplicate) <br /> --- <br /> - ---- ------ ---•--•------ <br /> Date Issued <br /> This Permit Expires 1 Year Prem Dale 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 existing Rules and Regulations- <br /> JOB _ _ ; nt; Oq� r3C CENSUS TRACT ---- --------_-_-------- <br /> Owner's <br /> ADDRESS/LOCATION ..------ 9- -----�---•-•------R--------�-•---••�-•-- ---�-•------- - ------°--------------- <br /> Owner's Name ----------------•---8099 :_ROP.----------•-.........-- -. ..------------_-------------•--:....--......----- --Phone 83710......-------- <br /> Address .....-.. .... 26J78 $ t tai--Aoad _. City ...T BPY-------•----------------------------••-•--•-- ------..... <br /> -- 186 -- <br /> Contractor's Name ._-pA,LM4UST-..PLUM$SNG-_-SVS.:............ License # -- 95 ._.__---- Phone -----83 ._. .-------- <br /> 94 <br /> Installation will serve: ResidenceXXApartment House(❑ Commercial❑Trailer Court f j <br /> Motelp Other ----------------- -------------------------- <br /> tLcerage <br /> Number of living units:..---.1--- Number of bedrooms _.3......Garbage Grinder --_-------- Loi Size ...-._-_-------------------- <br /> Water Supply: Public System and name ---------------•--- -------- ---------------.-------------•-------..Private 1X <br /> Character of soil to a depth of 3 feet. Sand❑ Silt;] Clay ❑ Peat❑ Sandy Loam C7 Clay Loam <br /> ME <br /> Hardpan ❑ Adobe❑ Fill Material ------------ if yes,type---------------------------- <br /> )Piot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 14. <br /> NEW INSTALLATION: JNe septic tank or seepage pit permitted if public sewer is ovailable within 240 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK I ] Size--------_-------------------------------------- Liquid Depth .-------------------------- \4 <br /> Capacity <br /> ------------ ----- <br /> Capacity -------------------- Type -------------------- Material---------------I------ No. Compartments ........... <br /> Distance to nearest: Well ------------------------------------Foundation ...---------..._------ Prop. Line ......._.............. <br /> LEACHING LINE [ ] No. of Lines ------------------------ Length of each line-----------.-- ------ Total Length ------------......._-------- <br /> �'"� 'D' Sox ------------ Type Filter Material ..............Depth Filter Material .------------------------------------­---- <br /> Distance <br /> ----- ---- <br /> Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line .....--._--___-------.-_ <br /> SEEPAGE PIT [ ) Depth -------------------- Diameter ----------- ---- Number --------------------------- Rock Filled Yes ❑ No i❑ <br /> Water Table Depth ----- ------------------------------ ------ -Rock Size .......... --- ------_--- -- <br /> Distance to nearest: Well ----------------------------------------Foundation ---------------.---- Prop. Line ...................... <br /> REPAIVADDITION(Prev. Sanitation Permit# ...............E}- ------------- Date ________1 6 -.---------..._) <br /> Septic Tank )Specify Requirements) -------------EXIAtl l ---.------.---..--.....---.-.------_-__------•- <br /> Disposal Field (Specify Requirements) ....:_.---I00_-1t7---f . A_-2 ft, wdeg_ _---1-div-e_rsion_ Rnx_____------ <br /> Supp3ementary to exfstzng 200 ft' -------------------------------- <br /> ------------------ ---- ............ ---------------------------------------------•-•------------------..._........... •-------------- --------------------------------- ------ <br /> JDraw 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 San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District,Nome owner or licen- <br /> sed agents signature certifies the fallowing: <br /> "1 certify that in the performance of the work for which this permit is Issued. I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ..-PALQP ------- <br /> tSERVIC <br /> _ <br /> � x- /"` Title <br /> Manager <br /> ......................... <br /> BY -------------------------------------------- / <br /> (If other than owner) -- <br /> FOR .DEPARTMENT U$VONLY, <br /> ' DATE <br /> APPLICATION ACCEPTED BY-------------------•------------------•• ----- __-Awl �e!'�--------. DATE __.­_.41:!:-- ---- --------------- <br /> ------------------------------------------- <br /> ------BUILDING PERMIT ISSUED ------ ---- -----------------------------•-------- ------- i <br /> ADDITIONAL COMMENTS t=�-------------------------•---...................---- <br /> •--------------------------------------•- --•--------------------•------ ------------------- ------------------ <br /> ---•---------- ------------------- -. -.------------....... {:. ....... <br /> Final Inspection bY ----------•------ ------------- ---...........--- ---------....--------- Date ..- _::_�.-f= _'. ------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'6$ Rev. 5M <br />