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f <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. _711............ <br /> ................"..._.-- -- --•----I................ ICompletein Triplicatel <br /> ................... . <br /> Dare issued <br /> ................... <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the Son 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/LOCATIO $ 7� .................CENSUS TRACT ........... •--•------- <br /> ..._..---... <br /> Owner's Name ...._. .... •.. .. .. .................... <br /> ._Phones ----••----...-._ <br /> .... � City _ •._...... <br /> .... _..._ . ._-. <br /> Address ,.. ----•._. � <br /> - License # _ <br /> -Phone .............................. <br /> Contractor's Name -- .._. _ - .:.-.License <br /> Installation will serve: Residence ❑Apartments House 0 Commercial []Trailer Court 0 <br /> Motel CX Other <br /> Number of living units:.... . r-J. Number of bedrooms -. V--Garbage Grinder Lot Size .. .--�_------ <br /> Water Supply: Public System orvd name ..... ........ ------_---------- --- ----. .--- ------ --- ---------- -•-_, i •� � <br /> El <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy LoamClay Loam <br /> Hardpan ❑ Adobe ❑ Fill Material ...___ If yes, type "................"--•----•-• <br /> — t location of s stem in relation to wells, buildings, etc, must be placed on reverse side.) <br /> (Plot plan, showing size of lot, Y <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT { ] SEPTIC TANK T ] Size.............................."-- Liquid Depth ...... ................... <br /> - a - <br /> Ca acit --- Type -------------------­ Material---------- -• .... No: Compartments ....... <br /> Distance 1 5 nearest: Well '. --._Foundation ....__._.---------_ Prop. Line ...................... <br /> No: of Lines - -. Length-of each line.... .....................: Total Length ....._.....-.............. <br /> ., <br /> i LEACHING LINE ( ] - , <br /> I 'D' Box .._.'. . Type Filter Material ........----------._Depth Filter Material ._.._ ........................_......._.._..- <br /> •._ "` Property line ... .... <br /> f Distance to nearest: Well 1.'a................ "-_. Foundation p <br />! R <br /> ' ' .. Number ------------ <br /> � Rock Filled Yes 0 N Cl ' <br /> SEEPAGE PIT { ) . Depth Diameter _ <br /> Water Table Depth --• --y - ............ ---Rock Size......... .................. <br /> ..__Foundation ............ ....... Prop. line ._.._....._._.__....-- <br /> = Distance to nearest: Well ...-..__.� =- <br /> I ,,.•�- - ,-.. -. - <br /> --------,Date -•------ -•---- <br /> REPAIR/ADDITION(Prev. Sanitation Permit <br /> Septic Tank S Requirements) --..... A <br /> (Specify ecif Y q uiremenp ._ . <br /> Disposal Field (Specify Requirements) _--. ------ <br /> ..._...---- . -- ............... <br /> ......... .---- <br /> . ....._.... "....... . .. ......... ... . .. .......... .... ----...--• -�----- - -�-- ---- --------• -------.......---�---�;_�—:_._� -ter--::_ <br /> ~--"(Draw existing"and required addition on feverse 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 Ordinance's, State Laws, and Rules and Regulations.of the Son Joaquin Local Health District. Home owner or liven- <br /> ' sed agents signature certifies the following: <br /> k "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 /> f as to become subject to Work n's Compensation laws of California." <br /> Owner <br /> Signed _:.......- <br /> Title ... ._ _........ : .... ........ .. <br /> --------- <br /> �- ' <br /> (If other than owner) <br /> _ FOR DEPARTMENT USE ONLY —_ <br /> . DATE 9.y .....................- <br /> APPLICATION ACCEPTED BY ...,.:._.. ----- •--- DATi _.......................... <br /> BUILDING PERMIT ISSUED .... <br /> ADDITIONAL COMMENTS .,....6 " <br /> ............. --------- --. -..-..--------------.... .-.".-._."..-...__... . -------- ---_-----......---................_.................. <br /> ---------------------•------------ •............ ..........•---- <br /> k ......... ---------- .... <br /> kP Final Inspection b <br /> YDate .. <br /> f <br /> ...- <br /> -•----•---------_----- .. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> W,... . _ <br /> � 7/723.� <br />