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' T - <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No.7 Z=_3_ _ <br /> f ------------------- ----------------------I------ <br /> (Complete in Triplicate) <br /> This Permit Expires 1 Year From Date Issued <br /> Date Issued <br /> -_--------------- -------------------------------------- <br /> Application is hereby made to the San Joaquin Local Health District for a per 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/LOCALON --------------------- CENSUS TRACT __:___ ____.________..Owner's Name ._ - --------------------- ------------------------ -----------=-=-------------------Phone •----- <br /> 06 <br /> Address --I--- --- = City.- -- <br /> --------------- <br /> Contractor's Name --------- -QQ -------------------------------------------------------License # ------------------------- Phone ------------- <br /> Installation will serve: Residence�Apartment House❑ Commercial :❑Trailer Court ;❑ <br /> Motel ❑ Other -------------- ---------------------------- <br /> {{ i - <br /> Number of living units:.__1_____-__ Number of bedrooms JR-----.Garbage Grinder A0---- Lot Size -C ------------------- <br /> 3 Water Supply: Public System and name --------------------------------------------------------------- ----------•-----------------------------------Leprivatx <br /> M <br /> Character of soil to a depth of 3 feet: Sandx-*ilttx Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe f❑ Fill Material ------------- If yes, type ---------------------------- <br /> (Pl'ot 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 Rublic sewer is available within 200 feet,) 3 <br /> PACKAGE TREATMENT { ] SEPTIC TANK Size____!: y_ - - --- ___y _-- --.- Liquid Depth a4!-------------- <br /> Capacity 5_620- Type :----- ------ Material_ -- -'-----____-- - No. Compartments 1�---------- ------ <br /> Distance to nearest: Well ---------------`� - - ---- Pro <br /> ---- -----------Foundation ---- -------- - p. Line=-------------- <br /> LEACHING LINE No. of LiInes �L_---_______ Length of ea h line_�ie 5-1____--__------- Total Length ----6-5_,► <br /> 'D' Box ---- ff <br /> �Q _ Type Filter Material _ __ _.__Depth Filter Material --i-1----------------------- <br /> Distance,:to nearest: Well --------------- ------ Foundation _.------------------- Property Line ________________--._.--- <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter _`____________- Number -___-___________ ________ Rock Filled Yes ❑ No 0 <br /> t <br /> WaterTable Depth --------------------------------------------------Rock Size ------------------------•------- <br /> Distance to nearest: Well ------------ ---------------------------Found'lion -------------------- Prop. Line ------------------ <br /> k <br /> R (Prev. Sanitation Permit# ............................................ <br /> ------•'------- ---------------------- - Date ----------------------------------1 <br /> SepticTank (Specify Requirements) -------- ---------- --- -------------------- ---------------------------------------------------------------•----------------------------- <br /> DisposalField (Specify Requirements) --------------------------------------------------------------------------------------------------------------------- --------------- <br /> ' -----•------------------------------ --------------------------------------=------------------------ , <br /> ------------------ ------------------------------------------------------------------------------------ --------------------------------- <br /> Y prep - --' -- <br /> - --------- - <br /> (Draw existing and required addition on reverse side) <br /> I herebycertify that I haveared 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. 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 issued, I shall not employ any person in such manner <br /> as to beco ubje o Wor mRonsation laws of California." <br /> Signed ,?�--------------- --'--- ---- ------------------- --- Owner <br /> By ----------------------- -------------------------------- Title ---------- - ---------------- ------------------------------- ---------- <br /> (If other than owner) <br /> FOR_ DEPARTME USE ONLY <br /> APPLICATION ACCEPTED BY _ -----------' DATE`!_-2-- -�.- `----- __ <br /> BUILDING PERMIT ISSUED -----' __ ____ --- ----L ---- --- DA -------- --'---------- <br /> ADD1T ONAL CO ME T __ _ 4A�YL - �- --------- ------------ <br /> Q .- <br /> � --- ---------------------------------------------------- <br /> ------ . . <br /> ------------------------------- - ----------- -------- ------ - <br /> 1 --- --- ---- --- --- ------ft---------------------------------------------------------------------------Zg�� --------------------- <br /> Final Inspection by: ___ _. - ---------------Date _3---- __: :- � <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> i <br /> E. H. 9 1-'68 Rev, 5M <br /> 1' <br />