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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No.7g.7.07,/--- <br /> ••------- - ------------ -----------------••------ This Permit Expires # 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 described, <br /> This application is mgde,ln-com {lance with County Ordinance No. 549 and existing Rules and Regulations: ! <br /> JOB-ADDRESS/LOCATION..... _ .TRACT... - <br /> - - . ........ <br /> Owners Name------•--- _ ...6 ............................ 7-Z/-237..---- ---•--------- -- ------ Phone... ...---------.. . <br /> Address------C?��.�.�.._ .-., fliS �i� --------- .Ci ----Zi <br /> Contractor's Name.....: - -License #-..-------•--------------_Phone------------ <br /> Installation will serve: Resi ence ❑ Apartment House❑ .Commercial _Trailer Court ❑ <br /> ,. Motel ❑ Other...- ---------- <br /> Nu <br /> = <br /> Number of living units:...............-Number of.bedrooms__..__..----Garbage-Grinder_._:-.------Lot Size_.,,.:.-___...._. <br /> Water Supply. Public System and name.................. Private 1 <br /> ElCharacter of soil to a depth`of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ' Sandy Loam❑ Clay Loam ❑ <br /> Hardpan'❑ -.rAdobe ❑ r Fill Materia ....... ____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.) Nv <br /> NEW INSTALLATIONc--(No septic tank•or seepage-pit permitted if public sewer is available within 200 feet,) O <br /> PACKAGE TREATMENT <br /> [ 1 , SEPTIC [ 1 Size.-_____..__� <br /> 02. 0-------•-•----•------- --------Liquid Depth-- ------------------ . <br /> Capacity­.................•Type---- ------------------Material_ .--------------------No. Compartments-- 2---------- ......... ' <br /> ' Distance to n'earest: Well). _. <br /> -!0.0.__..___-- O� <br /> ---..-�_-._._Foundation.-j__.•-•----------------Prop. Line.2 ----- <br /> a <br /> LEACHING LINE. [ ]. No. of Lines-------- .........:...._Length of each Iine._-_1 '----- <br /> ,04.__:- ___-_.Total Length ..._j00._.._._..,,:-:..___-____--- <br /> ' 'D' Box------------ <br /> Type Filter Material____________________Depth Filter Material----------._-._.__ hh tt <br /> Distance to nearest: Well_______ ____________________Foundation ------ ---------- ----------Property Line........ <br /> SEEPAGE PIT ( ] J Depth-------------_____Diameter____.._.:-----------Number_._.._-__---.____.-------------- Rock Filled Yes❑ . No❑ <br /> h Water Table Depth-------------=- ----------------------- ---.Rock Size----------------- ------------------------------ <br /> Distance <br /> --•--------- ----- <br /> Distance to nearest: Well_..._.______ Foundation........................__.Prop, Line______________ ' <br /> REPAIR/ADDITION (Prev. Sanitation Permit#----------------------- <br /> -------------------- --------Date----____:._.--------------------------- ( S <br /> ------- <br /> Septic Tank (Specify Requir'ements)--------- -----•-- ------------------------ ----------- ---------'.:_ . <br /> Disposal Field (Specify Requirements).................... _ A <br /> ---- <br /> ..... . -----------------------------•--• - -------------------------------- ----- <br /> — ------- -----------------•-- -.. <br /> -- _ <br /> f <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certify that I have prepared this.application•and that the work will be done -in accordance-with-'San Joaquin`Cotntity�:j <br /> Ordinances, State Laws,- and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents 1 <br /> signature certifies the following <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as <br /> to become subject to Workman's Compensation laws of California." <br /> Signed....... 11A( ft r.-,I tC(n.�.... - --------Owner <br /> By-� ---- . 6�.l.t. ,c�^e_ _v'2eY\---------------- .._... I <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. <br /> DATE .g �. ..7. <br /> ---------: .---- -- - - _ <br /> "u1VISION OF LAND NUMBER:.. ---------------------- <br /> -=--------------------:-.DATE------ -------------------- <br /> ADDITIONALCOMMENTS................ ...---------- - - -----------------------------------------•--------••-•-----•--•-------....•------•---•------------...------ ...... <br /> --------------------------=------------------ -- -- ------- <br /> = ------------------------------ --- <br /> Final Ins edion b _ _ . <br /> P y: --- ----C - - ------------------ --------------•--- - -----------..-..-•----... `- --- Date . .�.`j�_�� :......._ <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fay 21677 REV.7176 3m <br />