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rwFOR OFFIC USE: Permit No: <br /> 'LICATION FOR SANITATION PERMIT 7 <br /> � " <br /> ------------------------------------------------- (Complete in Triplicate) <br /> --------------------- <br /> -------------- Date Issued -��1��b , <br /> This Permit Expires 1 Year From Date issued <br /> ,yC;J �=� <br /> Application is hereby made to the San JoYaquin Coca Heal h7-D9striet for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ofdinance No. 549 and existing Rules and Regulations. <br /> F_ CENSUS TRACT -----12 <br /> JOB ADDRESS/LOCAT ON .___ �-�2� <br /> r- ---. -------Phone <br /> Owner's Name ._ ---- -•---------------------------- ----------- ----- - � <br /> / ACV p- ----------------------- - "" CA-�L�Q <br /> C <br /> Address ____ <br /> 7�__ hone _ <br /> icense --�--n------- <br /> Contractor'shame - <br /> Installation will serve: Residence Apartment Houser❑ Commercial ❑Trailer Court <br /> Motel ❑ Oth r / - ------------ -- <br /> Number of living units:------ Number of bedroom _Garbage-Grinder ..zr:.-Lofizef- �i � <br /> D�•44-- <br /> - - <br /> ---------- y ❑ <br /> Water Supply: Public System and name ------------------------ <br /> ---- --=------ ---------•-----•-- -------------------- ---------------- <br /> # I t Cla Loam . <br /> Character of soil to a depth of 3 feet: Sand[] Silt❑ ia�y ❑ Peat❑ Sandy Loam <br /> s ## ------- <br /> Hardpan ❑ � Adobe'❑ FN-N4aterial - _ 9 -- If yes,type --,----•------------- <br /> (Plot plan, showing size of lot, location of system In <br /> e ficin o wells: buildings, etc. must be placed on reverse side:] <br /> No septic tan or see) ag pifi,permiited#if p�blic sewer is availble with 200 feet,) (I <br /> NEW INSTALLATION: ( p i`€,C?r s P r <br /> Li' uid Depth -------•----------------- <br /> A Size--------------- f� p <br /> PACKAGE TREATMENT ( ] r,�SEPTIC <br /> T,- <br /> Material------------- -------- J�No. Compartments ---------------------- <br /> 2.7 Mat�-------- -------- Type - - n <br /> Foundation _. _-0--..---------G---- Prop. Line _. <br /> Sista c e to nearest: Well _�_______________ __ 11 <br /> N r <br /> I o. .of Linjs ------------------------ Length of each line----- ---- _ Total Length = <br /> LEACHING LINE ( ] i 4 <br /> p, oType)Filter(Material ------=--•-;Depth Filter Material.;-------------- <br /> ----- - <br /> _ -_ ,� - <br /> _� E S jFoundation ----------------------- Property ­­ <br /> �-st .nce to! nearest: We I -;---------------------_ <br /> SEEPAGE PIT [ ] DepihI- ----- - ----- Diameter ---------------- Nu er _._-- ---:-----------�- -y Rack Filled Yes ❑ No <br /> i <br /> Wat rTable Depth __� -=---�--- --------------------------------Rock Size -------------------------------- <br /> �sfi nce tol.nearest: Well -- ------------------------------------- <br /> Foundation Prop. Line .--------- q <br /> REPAIR/ADDITION(Preva itationlPermit# A----•- - ------------------------------ Date ---------------------------------- <br /> )I <br /> ---------•-----------•---- -----1 <br /> i --� - <br /> I -----------------------=" ------------------------------------------- <br /> Septic Tank (Specify Requ relnents) - ?�- � -------------- ----•------------------------ <br /> i �. <br />�- Disposal Field (Specify RequireLn s�` �� � ---`--------n6t�T----t 1-1-V -- �N Y - <br /> // r <br /> -�- - u�u�. -----= ----- ------- <br /> . . T <br /> -1 ---------------- <br /> * . - ­aL - -- <br /> -------- -----t-------- -- <br /> ------------------------------------------------------------- <br /> (Draw exisiing and required addition on reverse side) <br /> I hereby-certify that I have prepared this application and that the work will be done in a c rdance with San Joaquin <br /> County Ordinances, State Lo Fw;, and Rules and Regulations of the. San Joaquin Local Health District.dome owner or licen- <br /> sed a.gents signature certtfies:tke following: <br /> "Ify of in t"h p rfor a ce of the work for which this permit is issued. 1 shall not employ any person in such manner <br /> E 15gn <br /> to-become-suis)ect-to14WojrkrsiapsiCornpensa ion laws of California." <br /> ed � - J Owne <br /> ` --- - -- - ------- <br /> I ---- - ------- itle x7 ;" rZ- <br /> iov�ner}= _ �� <br /> 4, ;FO , DEPART, .ENT t1Sl= ON1 <br /> APPLICATION ACCEPTED BY ------�1 �_ _�� <br /> DATE _` E� ' --- ------ <br /> ---------------------------------,_._. ..�� ,._ - _ � ._ .__. r _D;4TE,. ._�_.... T.�..._w_ _•------------- <br /> ------------------ <br /> BUILD'1NG-PERMIT-ISSUED ------------------------- ----------- ------- <br /> ADDITIONAL COMMENTS ----------------------------------------- ----------------- - <br /> --------------------------------------------- ----------=-------------------- <br /> -__ ---------------------- <br /> -&:& <br /> __ - ----- ----- -- <br /> �_ .... <br /> --------- -------- ---------Date <br /> Final Inspection _ -------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> F <br /> E. H. 9 1-'68 Rev. 5M <br />