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FOR OFFICE USE: <br /> ;;COR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No.7 <br /> --------- ----- ---. ....-- <br /> •- ..1-=•-�-7-- �" <br /> (Complete in Triplicate / <br /> .... ........ . Date Issued..[. ..... . <br /> __- This Permit Expires I Year From Date Issued I - <br /> Application is hereby made to the San Joaquin Local Health 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 existing Rules and Regulations: (� <br /> '^ CENSUS TRACT... -- .. --. 9 <br /> JOB ADDRESS/LOCATION--- �, -------- /u� C ------------------------ r� <br /> Phone.. .. ; / ..... <br /> Owner's Name. <br /> ---------- . ...... - � :: <br /> --------------_-- <br /> City��-!lTG�C.-�. .-....... Zip------; <br /> Address-_ -.-....-- - _ _ <br /> �..C� 1..-c/-�- ----License # � ..t1 fir .Phone_1576 T, <br /> Contractor's Name.__ S <br /> Installation will serve: ',,Residence � -Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other__...... ry 72-I. .......-- u. /�C <br /> Number of living units:_....-----.__Number of bedrooms.... ..Garbage Grinder----------.-Lot Size...-- 4- - " '" <br /> . <br /> Water Supply: Public System and name ---------- " ----:----- -------- • - - - - --------- ...... ... f="--- <br /> --------------Private <br /> Character of soilto a depth of 3 feet: Sand ❑ Silt ❑ Cloy ❑ Peat ❑ Sandy Loam ] Clay Loam <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 placed on reverse side.} <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) g f f O <br />�I <br /> _ .:/ �`� ------Liquid Depth.. ---- � . .. <br /> PACKAGE TREATMENT [ ] SEPTIC�TA�N,`K [ ] Size.. --- - -• <br /> Capacity���"-------Type-�n - 5Material-- --------=----------- Com partments.._..._ . ,.... <br /> Distance to nearest: We11...-. ----- --- • ------ <br /> F�oundation..fa �w:r...._.Prop. Line. . -- ----- <br /> �7 <br /> Length of each line ..- h -------------- Total Length .---.-�-------- --- ---- ----- <br /> LEACHING LINE [ ] No. of Lines .... -------------------- g <br /> /,5p i/ P4 <br /> D' Box.. ...... Type Filter Material// <br /> Filter Mater�al�..--- ------------ ------ t <br /> 1 <br /> ..Property Line...� .._..-- �.. -"-- <br /> Distance to nearest: Well..�� ... ------Foundation---3-0.....- --. . p Y <br /> SEEPAGE PIT [ ] p --- Rock Filled Yes ❑ No <br /> ,. Depth..---- ..Diameter. --- ------ -- � Number �---------.-�:-- ----••-�- <br /> -- - -------Rock Size.... ------ -------I--------- <br /> Water Table Depth-------...-�-------------------------��- �- - <br /> gistance to nearest: Well------------------------- ......._._.Foundation..... .......... .......Prop. Line..-- --------- -- --- - <br /> REPAIR/ADDITION (Prev. Sanitation Permit#-------------•--- •...._----- -- ---- ----------Date--_-.------------------- - ...... --------� <br /> -------------- <br /> Septic Tank (Specify Requirements)-------- ------ ......... ..... . ---- ..... <br /> I Disposal Field (Specify Requirements).................. .. •---•- = <br /> j - _ -fr--------------- ----------I ----------­------ ....... ------------- <br /> .........................................-----............_.-------. <br /> ew. ........- <br /> ---------------- --- --------------------------------------------------- ---------------- 1 .^. <br /> p application{Draw existing and required addition an reverse side) <br /> I hereby certify that I have prepared this a lication and that the work will be done in accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, home owner or licensed agents <br /> i 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 icis <br /> to become subjectwt Wor an's Compensation laws of California. <br /> f , <br /> Signed - <br /> By---------------------- Owner <br /> ' Title--- ----------------- -----�--.... -- ...-- .-........-----��- ��- <br /> -•.... ........ . . <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY........... s... _ --- ------ ----:-- <br /> �, ...... .......DATE ..._.- <br /> DIVISION OF LAND NUMBER.------- .... ---- .. <br /> _..-..DATE... - --- <br /> P . . ............................... ......---.... <br /> . <br /> ADDITIONAL COMMENTS_.----------- <br /> ! -- ----- ----- -------- ------------ ---- ----- ----- ---------- -----------�-•---• ------... . ..... ..... ... <br /> --- - <br /> 54-7 <br /> - • - -... <br /> Final Inspection b ate.... <br /> y'___-.-..._..-- -- - ... .- - F& 23677 REV. 7/76 3M <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT <br />