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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. _7.a <br /> p (Complete In Triplicate) <br /> -------............ ................ ............. <br /> This,Permit Expires 1 Year From Dole Issued Date Issued <br /> Application is hereby tmade 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 ADDRESS/L ION .. 9 .S�W.:,+ Lrl< P .• �` CENSUS TRACT ......................... <br /> Owner's Name ----- - �............................................... ......... ....--Phone.......1`-................ <br /> - ._... <br /> Address ---------r-�-- W. - City Q .. -------- -------------------- <br /> ---- <br /> ---------•------- ........:. - <br /> - `. ----.License # � i17��Y.... Phone .-----....................... <br /> Installation will serve: Residence ®'Apartment House(] Commercial j]Trailer Court j] <br /> Motel,❑ Other -----------------------.-------.......... <br /> Number of living units:---------/- Number of�bedrooms ...sg-----Garbage Grinder -...y.... Lot Size �r..7L-�i1C-�f Water Supply:Supply: Public System and name -------------------------------------------.....-•------------------...................---.............Private <br /> Character of soil to a depth of 3 feet: Sand j] Silt)] Clay Peat❑ Sandy Loam ❑ Clay Loam❑ <br /> Hardpan ❑ Adobe 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 /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ I SEPTIC TANK): 1 Size..................._------------.'.------------- Liquid Depth -----------A....... <br /> Capacity ...._.............. Type ----- -------------- Material------ --•----------- No. Compartments ..............•..... <br /> Distance to nearest: Well ---_...............................Foundation ...................... Prop. Line .......... ........ <br /> LEACHING LINE ( ) No. -of Lines ........................ Length of each lini............................ Total Length <br /> f <br /> D' Box ............ Type Filter.Material ....................Depth Filter Material ...... ..................................... <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 /> t <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................--------------.) <br /> Septic Tank (Specify Requirements) -------------------------- ------- - .................................... �-.`------- <br /> Disposal Field (Specify Requirements) ...fir.-f .e'�....- -. -��•c.�- .-£ - - - - ----- --- -------- ••• - -- ------�'--'-!-`-= <br /> ...r.._. X $-D <br /> - V <br /> .................-J. ....-......a............---------.-----------...............-- --... <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, and Rules and Regulations of the San Joaquin Local Health District. Homo owner or licen- <br /> sed agents signature certifies the following: . ' - <br /> "1 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 to Wo man's Compensation laws of California." <br /> Signed -------------------------- - --=----'------- - _ -- -- Owner <br /> By ................................ .. . ......--- - _--- --- b -----. Title .'. ..-------.....---!y r% ------------------------------- <br /> (If other than owner) ., <br /> FOR .DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ,_ILx_ 4th---------- -------- ------ ------ ------------------ DATE ./._Q_------------------Zc7-- _...... <br /> BUILDING PERMIT ISSUED ............ .......-- - ---=-- ---------- ----•----- ........DATE - ---------------.......------- <br /> ADDITIONAL COMMENTS ---------� �,f------V ........ , --'S-----------------------------------------------------. --- --------------------- <br /> -------------------------------- ----------------------- -- ..... ----------------- ---------------...-----------..............................---- ------......... -- ....-....----- <br /> ......... . -- _ - - ....... ...... - .......... ................... ---- ............................_.................... ......------------........ . . <br /> .............. - --- ---- <br /> ------- <br /> Final Inspection by: ....--- - -- -c—G-lam---`.- ----------------------------------------------------------- <br /> SAN JOAQUIN <br /> - Z-�-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />