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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT � _ <br /> ----------------- - ------ <br /> ---- Permit No. -7 ---- <br /> (Complete in Triplica e) <br /> ----------------- ------------------------------ - - �` t1 <br /> ::�+ •� �.. �.� , ,, It� Date <br /> ----------------------------- --------------- This Permit,Expires 1 Year From Date Issued: -t ' <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-------------------------------- <br /> JOB ADDRESS/LOCAJJQN--------------------- <br /> Owner's <br /> -------- <br /> , f <br /> - ------------- ----- <br /> c <br /> Owner s Name --- ..E ----r--- --t-------- --- ---------- <br /> Phone. <br /> -A• <br /> Address. ; -- ---- -City Zip <br /> r <br /> Contractor's Name '' .0_ y ..* ------------------=---- :License #[�.? 5. Phone y 1"�' <br /> Installation will serve: ` Residence Apartment House ] Commercial ❑ Trailer Court. ❑ <br /> . ... � r-- rbd e Grind ------=- - =- <br /> Motel "';other- = - - <br /> Number of livirig units:_- _..1 Number of bed oms.�..._.Ga g er .._Lot Size._ X_ c�- --------------------------- <br /> Water Supply:PLib'Iic System.'and r arae= G�/ r �� s Private <br /> Character of,soil,to a depth of 3 feet: Sand EJSil �„Clay ElP.eat fl Sandy Loam [I Cloy Loam El <br /> Hardpan E] : Adobe Fill',Mateiial---- -------If yes, type-------------------------------- <br /> �` <br /> (Plot plan, showing size of lot, location of system in relation to'wells, buildings, etc. must be placed on reverse side.) ; <br /> P <br /> p P <br /> pit if ublic ewer P p r is available within 200 feet,) <br /> NEW INSTALLATION (No Septic.tank or see a * /j� <br /> s � <br /> k Jez <br /> PACKAGE TREATMENT [ ] ` SEPTIC TANK ( S'ze_____ ____7 Liquid Depth.------------------------- <br /> Capacity, = == -:-Type. Mate <br /> I. + � : T e. .�+E ---,--:--- lf t L,y C-_-" �o. Compartments.. -'-- <br /> •ria ------------------' <br /> }. istance to neares • Weill, ,t//ea---------------------Foundation_,_... 0 --------Prop. Line. �_-----' <br /> t <br /> E y� <br /> LEACHING LINE [ No. of Lines---._____----.:Length of each line-- _U`_- -_-Total Length __j. Z�. <br /> f <br /> D' Box TYPe Filter Material lid-- _ P ---------- - <br /> De th Filter Material_____I ----------------------- <br /> Distan to nearest: Well- _ ____.__ --Foundation----./U..-_.---------.Property Line____ f------------------- <br /> SEEPAGE PIT [ ] Depth_.__v� _-D1ameter.-,- :. -----Number___:.._.............. Rock milled Yes <br /> I <br /> Rock Water Tabl� Depth---,-----;-_-- / -=--------------- _ - � <br /> Line. _ <br /> _Foundation : ProP.Distanceto nearest: Well <br /> REPAIR/ADDITION (Prev. Sanitation Permit#-----------------------------------------------------Date-------:----------------=----------------------1 <br /> V ..... <br /> ---------------------------------------------------- --- --------------------------------- --------- <br /> Disposal <br /> -------- <br /> Septic Tank [Specify Requirements)...."•. --� ; <br /> Dis osal Field (Specify Re uirements)- ,-_. ` <br /> t ----- <br /> ...................... . <br /> ...----------------------------------------------------------- <br /> ..... .l_....-------------------------------------------------------------------.----------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that"I.have prepared this application-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 /> isignature certifies the following: i <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as <br /> to become subject to Workman's Compensatiost laws of California." <br /> Signed -P -- -----IV - OWnerr <br /> t . ` . <br /> ------- <br /> -Title 1- <br /> -------- <br /> (If'other than owner} <br /> t t DEPARTMENT USE ONLY { <br /> APPLICATION ACCEPTED. BY.----_. D E.-- _-� �= =--=------------- <br /> .. -•- ------. ---------- ----DAT <br /> DIVISION OF LAND'NUMBER- -- :- ------- <br /> OM ` f ATE-------------------=------------------------'- <br /> f_. -...__•....................... .... ....___......--. <br /> ADDITIONAL CMENTS- --- ' ) <br /> i ------- ------ ------------------------------------------------------------------- -- ------- <br /> ------------- <br /> : -- - -! <br /> ------------------------------ <br /> t ---------------- I--- ---------------:_ ---------- ------- -- ----- ------- ..-.---- <br /> - -------- - ---------------------------------- <br /> Final Inspection by:--- j Date' s- 7 <br /> F85 21677 REV. 7/76 3M <br /> EH 13 24 �, s SAN JOAQUIN LOCAL HEALTH DISTRICT <br />