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FOR OFFICE Ust.elis <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate] Permit No.7_7.-.3.?.._3 ' <br /> ------------------------------------------------ � <br /> Date lssuec!45.45 .?. <br /> ..................... ........... This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the Son Jooquin=Local Health District for, a permit to construct and install the work herein described. <br /> This application is made in cornplioncef"fh''County Ordinance No. 549 and existing Rules and Regulations: <br /> .............. --- --- ---- ------ <br /> JOB ADDRESS/LOCATION Vaf.... ....CENSUS TRACT--.-,,. .............. <br /> Owner's Name.__.. ........ <br /> . . .... ............ --------------- ......... ----------.Phone------------ :-------- --- ........ <br /> 11 <br /> Address city_ �.... <br /> ...... - -- -- - - --------- ... ....... ... ......I _ zip------- ........ <br /> Contractor's Name.....-------------------- --- Licens -......Phone -- --- ..X).. <br /> X <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial 171 Trailer Court.C:1 <br /> Motel F-1 Other---------------------------------------------- <br /> Number of living units;-5h8.jiP...Numbp' r of _Garbage Grinder.... -------Lot Size ...... <br /> Water Supply: Public System and nome.1.1.... .................... ..................................... -------------.Private <br /> Character of soil to a depth of 3 feet. (Sandk Silt E] Pay 0 Peat ❑ Sandy Loam Ej Clay Loam E] <br /> Hardpan ❑ Adobe E] Fill Material.. .'. ....If yes, type---------------"....------._... <br /> (Plot plan, showing size of lot, location.'of system in relation to wells, buildings, etc, must be pl-aced on reverse side.) <br /> NEW INSTALLATION: (No 'septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK Si- <br /> ze. ..... ----. LiquidLiquid Depth._.:=--- <br /> Capacity...t-2- 0. TYpe __X�---------_.............. <br /> ... ...... ... N6, Compartments.... <br /> Distance to nearest. - _-------_---Founclation_'­ ....Prop. ........... <br /> V <br /> LEACHING LINE No. ✓of Lines -----------------Length of each line........7-P./---------- --Total Length .. .....7,0' <br /> ------------- <br /> .D <br /> Box.-.I--...Type Filter Material <br /> ...:.... .:......:.Depth Filter Material /I:.-d--a-`' -----------------I -------------- <br /> Distance to'nearest: Well------- Foundation.......$7'­`.___._..Property Line---tf................. <br /> SEEPAGE PIT 'Depth_ Diameter.:....:.............Number--.-..._-----------.------------ Rock Filled Yes [-] No <br /> Water Ta­9'le__Depth............ ..111k <br /> ------- .........................Rock Size.-... .- -------------------- ..........­ <br /> Distance to nearest; Well---------------------- .. . .....Foundation.--------. ---.- -- Prop. Line �::-----:-- --------._- � <br /> REPAIR/ADDITION <br /> oundation--------- <br /> REPAIR/ADDITION (Prev..Sanitation Permit#---------_----------------------- -__----------Date ............. --------- ------ <br /> ---------------- -------- ------------------- <br /> Septic Tank (Specify Requiremenisl --------------------------------------- ------------------------------ <br /> DisposalField (Specify Requirements)........ ............. --------- --- ...... . ------------------------------------------------------ ---------!----------- --------- <br /> ............................_-- - ----------------------E----------------------­- ......................... ......:----------------------- ---- ---------------- -- ------------- <br /> --------------------i---------------------- ------- - ------------------- <br /> -------­--------- ------------------------------------------- ---- --------I------ ----­----------­---- -------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify thatA have prepared this application and that the Work will be done in accordance with San Joaquin County <br /> Ordinances, State Law' i, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies thd,folloiwing: <br /> "I certify that in the,.pe ormance of the work for which this permit is issued, I shall not employ any person in such manner as <br /> to become Zto;Worm so en tion laws of California." <br /> - -- ----------- <br /> Signed-- ....Owner <br /> By.......- ----------------- ................ ............ <br /> ___­........... _----------------- <br /> (if other thbn owner)'- <br /> FOR DEPARTMENT USE ONLY <br /> 57 Q <br /> _,,_ .� . .......... <br /> APPLICATION ACCEPTED BY---------/<V.' ­-­------­----------- ----------- --------------------r.DATE ............ ­... ... .7.. <br /> DIVISION OF LAND NUMBER I-- <br /> - _ _-... ..... ... ....DATE...................... .. .... ------------ --- <br /> ------------------ ..........L.. . ..... .......................... ..... <br /> ADDITIONALCOMMENTS-- -------------- ......... . ...... --------------------------------------- ------------------------------ - ----------------------I- -------- --- --- - <br /> ................. ---------------------- -------------- ............... . ... ... -----------­-------­­ .................. ------ - -------- ----------- .................. <br /> ---- ------ ---------------------------­_­_'­-------­--------­---- ------- ---------------------------------- -------------------- ------- <br /> ------------- ----------—.1-------------- - ­.......­-------------------- ---------- ------------- - - -------- -------- - <br /> - ------------------ ------------------------------- 7 <br /> Finalrinsp6ction by ......... ...... - --- -------------------------- ----------------------------------- ---- <br /> 3M <br /> FH 13 24 S 2.677 REV. 7/76 <br /> SAN JOAQUIN.LbCAL HEALTH DISTRICT <br /> 'C', 4! P. <br />