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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ............... ....................... .............. Permit No. 7 ; <br /> (Complete In Triplicate) <br /> .....................I............ This Permit Expires t 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 existing Rules and Regulations.- <br /> L-., <br /> egulations:L-., ct f <br /> JOB ADDRESS/LOCATI N o ��` C7 J... . --�!lkkf...�/...� 117KI...................CENSUS TRACT ............,./.........:.. <br /> Owner's Name ....... ..... f .C!_1. ...... f�1.!`�.5 ! ..1�'.•-•--.. SVG. -...........:................Phone <br /> f� <br /> Address ... ............................ !`HTx,-3............................................ City .......... . .�.1.r..�.?...(.9------�-7•-K-?....... <br /> � R ��Contractor's Nam ...License # .................... Phone <br /> Installation will serve: Residence❑Apartment House f] Commerclal[]Traller Court 0 <br /> Motel ❑Other.0 ....I .p. .�...__ <br /> p <br /> Number of living units:-... .. Number of bedrooms Garbage Grinder ............. Lot Size ............ <br /> Water Supply: Public System and name -•.......:..:.....................:_..............-•----.....•---•-..........................................Private ❑ (J� <br /> Character of soil to a depth of 3 feet: . Sand t3 Slit.❑ Gay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ 1 <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 planed on reverse side.) d <br /> NEW INSTALLATION: ([Na setpermi <br /> seepage pi , tted if public sewer is available within 2413 feet,) <br /> PACKAGE T.REATM NT SEPTIC TANK � / � •.`� <br /> , ..i ... -- ........ Liquid Depth ... ... ._....... i <br /> tl <br /> Capacity � ..� -•.. Type - s Material.. iY No. Compartments <br /> P ... <br /> ............. <br /> Distance.to nearest: Well 1.0.0... '........Foundation ...�.�f ............ Prop. Line .........._.•......... <br /> { <br /> LEACHING LINE No. of Lines Length f each i e. �Q_....---.------ Total Length ------ .f......... <br /> i 'D' Box" _.-. Type Filter Material ._`.... _ Depth Filter Material ...1 ; ........... ........... <br /> i Distance to nearest: Well ........... Foun tion ..... ........ Property Line .... K. <br /> SEEPAGE PIT � Depth --- - ----------- Diameter �..�._.�Number . ._. . Rock 4 ed Yea � <br /> - No 47 <br /> ®- - -------------........----.---•--.Rock Size -, .... ..... ..� <br /> Depth -•-- Q-- <br /> Water Table <br /> Distance to nearest: Well .. ...........Foundation .. p ... Prop. Line <br /> 11iEPAII}/A00ITI6N jPrev. Sanitation Permit .. Date ................... ) <br /> SepticTank #Specify Requirements).-----...-..----...................................................................-........................................................... <br /> Disposal Field (Specify Requirements) -------------- --.... ...... <br /> -- <br /> --------------------- -------•---- ----•- ---•-- -. <br /> ..__- ...................................... ...... .......................... ................................... <br /> �._�(Draw existing 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. Horne owner or licen- ' <br /> sed agents signature certifies the following: <br /> "I certify that In the pe rmance of the work for hich #his permit is issued, 1.shall not employ any person in such manner <br /> as to beca�p sect t ork�man�;�s Carnpe satlo Ia of California." <br /> Signed �( r f =---1"Q.. ...... '.. ... ..- ---- --------- _. <br /> 5 <br /> BY ----- - - - ---•--•--- --------- --- ------ Title -, -- ---•-- <br /> jlf other than owner) - . <br /> _ FOt( DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ...-�'= �•'• - DATE L,:Zr„�.��."_�.. --- <br /> BUILDING 'PERMIT ISSUED --•------------ --------------------- .......................................................DATE ------ ----------------------- .......... <br /> ADDITIONAL COMMENTS ---------• -------- . ................. <br /> -•------------------- •------ ---- -------------.........................._...-----------•.------._.._..-----•...._._.._ :'. . ................ <br /> -- --- <br /> FinaInspection by ..-• --------- ---- ------------------------•----------------•---------- ............._..-Date l <br /> EH 13 24 1-'8 aev* 5m SAN JOAQUIN LOCAL HEALTH DISTRICT /7h 3M <br />