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t <br /> FOR7bFFICE USE: FOR OFFICE-USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> .�. <br /> -----------------•- --•--------------- - Permit No. -7 ............... <br /> }_!'2.7 .� - <br /> {Complete in Triplicate) <br /> --� .•y Date Issued <br /> ....._ .`------------:...........................:..._. This Permit Expires 1 Year From Date Issued <br /> Application is?Hereby made to the San Joaquin Local I-lealth,District for a.permit to.,construct and install the work herein described. <br /> This application is made.in compliance With-County Ordinance"-No. 549 and ex-fisting Rules and Regulations: <br /> JOB ADQRESS/LOCATION.__._..{_,;.__.-_'_'___.�.J+.. .J` _..__ _.'e � 'AiL} ._�j�lG _. NSUS TSRACT...._.___._.......... . .... <br /> r � _ . <br /> Owner's Name d'.e' ,S�-1�. -------.Phone _ _(? 3 <br /> Address._._'.............. S -7-.5! --.zip---l�. <br /> x. <br /> Contractor's Name... <br /> B <br /> --------------License 0 " Phone. <br /> Installation will serve: Residence ❑ Apartment House 1 Commercial ❑ Trailer Court ❑ 1} t <br /> Motel ❑ Other::. e_��-,ee�V ------ 1 <br /> Number of living units: _ _.. - -Number,of,bedrooms _. �.�.-• - <br /> �_.__ 'Gacbage':Gra'nder Lot Size:.. : .. �'� <br /> t t � F <br /> Water Supply: Public System and name"'- :-:: 4------- ------------ -------- a.: • •-- j---- ------ ----- ........... .-Private <br /> Character of soil to a depth of 3 feet: 'Sand Q 'Sift❑ 'Clay ❑ Peot-❑ Sandy Loam ❑ ;Clay Loam�� <br /> Hardpan`.❑ Adobe❑ Fill Material-.----__---_If yes, type__. .............. <br /> (Plot plan, showing size of lot, location ofsyste`m in relation to wells, buildings, etc. must be placed on reverse side.} i <br /> NEW INSTALLATION: (No septic tank !or.seepage,�it permitted if public sewer is available within 200 feet,) c •' <br /> PACKAGE TREATMENT +� f <br /> [ �] SEPTIC TANK I } ' 7 Size----•-,-`� ,/`--1-a ,�---------� ----------Liquid Depth --...--• ------------- <br /> 00 <br /> - - ------.. <br /> Capacityl�,Q y�pe c Material iL ' �L-f i Compartments-___._ .._S.._._.f._...�._� <br /> 1 I <br /> s <br /> Distance to neares <br /> - Well--.-./.__ _�.................... _Foundation-.-:. ..__.__._.___.Prop. Line,-, _........ .__` <br /> LEACHING LINE. [ } No. of Lines-:...,.__ t_ _ Length of a�h line'.'.':: Q:_.,:,.___Tota) Length...-_ r1._'..... ....... .. <br /> Al <br /> `D' Boxcl." Crype Filte-Materiaeptkfilt6r`ltill'a -.. .__rl..._..___.__.______ <br /> Distance to nearest: WelLt..____�j��T...-------Foundation------`a...............Property Line.... 3.1_____ ._______.. <br /> �X , ----------- 1 Rock Filled Yes' No nC <br /> [ J Depth__ if.__..Diameter..,...._ -. . umlier._.__..._z'� � <br /> S t Table!Depth- '------ = :....._,__ Rock Size �. ----------- ------ <br /> Wo <br /> / ` <br /> A 11. 1 � � � / <br /> Distance.to nearest: Well.___...�.q? ...:........:......Foundation_. -- ___._-___--- Prop. Line--------- -- -_.-_.1 <br /> REPAIR/ADDITION (Prev. Sanitation Permit#-..._.---, ------------_- ' _____________.Date_.___.__ ................. _R,....... <br /> Septic Tank (Specify Requirements)--:..:#.....__._ <br /> -----------------------=-------• ---- ---- --------------------------------------- <br /> t -- -• . -- <br /> ...................... - <br /> DisPosalField (Specify. -• -------------------------- -•----••-•-------•-----------------••--•----ris__. ...---=---------•--------'-•--------... <br /> = - - °.----------- _----- <br /> ... <br /> -- ------------------ ---------------- ........... -------- ......................... ----- ------------- --- ---------..-.-. <br /> 4 <br /> i <br /> (DraWe:xi sting and..,required addition on reverse side) ' <br /> I hereby certify-that I-have•prepared this application and�th'atrthe work will be done in.actor`• dance withSan Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the Sa"9o`aquin-Local,+14alth District. Home owner or licensed agents <br /> Sig <br /> nature certifies the following: <br /> ( 1 ' I / = <br /> "I certify that in the perform6nce'of the work for which this permit is issued, I shall not employ any person in such manner as <br /> to become sub'ect to or cm `'s ComBensation law of,California." <br /> Signed------ 4,Y,& Owner `� 1 <br /> A <br /> - s - •ate / '. --•-.- �7 i' .. <br /> gY-------- - � - - -�� -- - .� •�-.- . - -trr.J------------------------Title--U ��`---- ---------------------------------- <br /> (If 'other than owner) ''• <br /> �f i <br /> ! _ FOR DEPARTMENT USE ONLY' i <br /> APPLICATION(ACCEPTED BY:'OL-4'.*.. A. l!✓Q5---'-•----.......:'�--------.._DATE........ <br /> DIVISION OF LAND NUMBER_t'�..__......... ------------------------------------------ =: ;r '� :.f DATE�a -,........ ----_.---..... --• <br /> ADDITIONAL COMMENTS------ � r...................... .._....- ....................................r--- •........... --- -- -- ........ ' <br /> ------ - -- <br /> ---- ------ - ------ ------ ---------------------------------------------------- • -- --=- •--------...---------------------------------------------------------------............................................................ <br /> - <br /> Final Inspection by:- ---- ... - " --•---_- ----------�-----•--------------------Date.:......T- �Q � --- <br /> EH 13 2A SAN JOAQUIN LOCAL HEALTH DISTRICT Fas 21677 REV. 7/76 3M <br />