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s a <br /> FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> - ---------------------- Permit No.__7 / <br /> G- lete,in Triplicate} „ <br /> 7-3 <br /> �.� <br /> ----- <br /> ------- -------------- p y �s y <br /> - ,. f-.e� Date Issued- <br /> ----------_-- ___.__._. i This Permit Expires 1 Year From Date Issued <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 /> �_ .[� - Y ,-._.CENSUS TRACT-------------- # <br /> JOB ADDRESS/LOCATI .- --- <br /> • i <br /> o e <br /> Owner's Name-.-- i <br /> ------ - --- ---- -- <br /> ___ Ph n� <br /> ' City. ------------!---Zip---------- --------- -- <br /> Addressd t : __ t .. <br /> " <br /> 1.2 <br /> Contractor's Name- <br /> UT }License #c-2 LI-��---------- Phone--` - -------- --- <br /> �_.. <br /> Installationhwill serve: Residence Apartment House ❑,. Commercial ❑ ,Trailert ❑ `! <br /> ' <br /> 4. '..... _,. _ Motel ❑ Other-= <br /> ' <br /> . �,i t <br /> Number of living.units __Number Qf_bedroiims Garbage GrinderLot,Size <br /> Water Supply: Public System and name-----f.-;-`-.----.-_;r _------------------- =: - -- ----.- ---- -------- .------'-`--------------------- Private <br /> pp Y= Y , , <br /> Character of soil to a depth of 3 feet: ; Saner " Silt-,E] 'Clay, ❑ Peat ❑ Sandy Loam ❑Clay Loam ❑ 4 <br /> ..'... a- - i .r <br /> Hard an Adobe. •Fill.Material_.._.__._i__If yes,type____________________________ _ <br /> (Plot plan, showing size of lot, location of system in relation fio'wells,ibuil.dings, etc.:must be placed on reverse side.) e <br /> ;.. 61 <br /> _ Gi <br /> NEW INSTALLATION i' ' (Na: septic tank"or seepage pit permitted-if public sewer is available within 200�feet,) <br /> I"l <br /> PACKAGE TREATMENT .(.-].' ,-SEPTIC T-A- NK -1 <br /> Size, i ------------ Liquid <br /> t <br /> Depth.; <br /> ------6 <br /> - -------------------- 1_No. Compartme�ts.CapacitY----' --�TYPe' = Material---------==---- - <br /> t <br /> -Distance to nearest: Wel.I--•------------------ --- --- -,...._.__Foundation-_�--- Prop. Line-------- - ----------------- <br /> LEACHING LINE . .0]l:. Na. of Lines :-.Length.oIF eac�e:---= -- ----- Total Length. ' <br /> 'D' Box--=----- --Type Filter Material _--- --I----Depth Filter Material------------------------!------ ------------------- ------'---- <br /> Distanceto nears .. . . _. . _----- �. ,- k ----- ------- <br /> rest: Well-"-_-`- ----� - -,--- -Foundation---- ---- ---------- Property Line--s------- -- <br /> ' <br /> - 7 ! FSI{ Y N <br /> SEEPAGE PIT ( ] Depth---- Diameter.'---`_.-_- ------.Number---=------------------ --3 R k ed <br /> - - - - - - , __________ ________________ <br /> t Water Table Depth. ---- -------''= --=---<-=�_ '--------------:---Rock Size:--- -' ----;--- -=-- Q- <br /> , # . . <br /> I C z Distance to nearest: Well---------------------- ------ Foundation._ -----------Prop, Line.--------------------- -� <br /> REPAIR/ADDITION (Prev-;Sanitation Permit#-------=- =--- ----------------------Date------------------------------------- <br /> Se <br /> .__.------------------�_---} <br /> ` Septic Tank (Specify Requirements)-_1.......: ' ---- <r ------------------------------------------ ------------------------- --------- <br /> �t <br /> ----- <br /> ----- ---- -------- - - -- <br /> --- 3.� ' <br /> Disposal Field (Specify Requirements)-- l - ------- ----- .f--- ------ <br /> z { ----- - ---------- --------- <br /> ----- ----- ---- --------- --------- ----- ----------------------- --: ------ <br /> t -------------- <br /> r • <br /> -----=-------------------- ----- --- ----=-------- ------ ------------------------------------------------------------------ - <br /> - (Draw existing and required ad'aitionon reverse side) <br /> I hereby certify that I have prepared this application and that the-work will be done i'n 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 /> signature certifies the following: <br /> "I certify that in the peiformance`o f.the work for which this permit is issued, I shall no' employ any person in such mariner as <br /> to become bjec to Wor n'S J Co..penscition laws of. California.' <br /> Signed_._ -- -- --- ------ ----- - - -------=------ = 0 n <br /> w Ew <br /> - ----------------- --- <br /> if other thdn' nes} Title a <br /> -------------- <br /> -------------- ----------- <br /> s <br /> I t _ . <br /> `FOR DEPARTMENT-USE ONLY <br /> APPLICATION ACCEPTED BY ------------------------------ QATE -�-J 's' <br /> f ------DATE-- ----------------- - --- <br /> DIVISION OF LAND NUMBER;.___..--------------------- <br /> ----- =---------------------------------------------------- <br /> ADDITIONAL COMMENTS--- -------------- ------ - ------------------------------ ------------ <br /> -------------------- <br /> ------------------- <br /> r ---------------------------'---- <br /> F---------------------------------- ------------'r--------------N---"-- _ _____( .__-______ Z <br /> --------------- -------.- --Final lns ection b - _ --�f----Date:---- r' ------p Y:��-".'.- <br /> EH 13 24. / SAN JOAQUIN LOCAL HEALT RICT F&S 21677 REV. 7/76 3M <br />