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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7.3 <br /> Permit No. .... .............. . <br />---------------..-----.._.........._......_ ........ j (Complete in Triplicate) <br /> f <br /> Date Issued <br /> . ............. <br /> .7U <br /> ... .............................. <br /> This Permit Expires Y Year From Date Issued t <br /> Application is hereby made to the San Joaquin local Health District for a per to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549'and existing Rules and Regulations: <br /> 01 <br /> .._.._... <br /> JOB ADDRESS/LOCATION ... •.•........ ..CENSUS TRACT / ,. <br /> 3. :.... .. .. ... ...._........_... ...... <br /> 9 .. .t--..�..�. --- .Phone .`,t�a `...........-�---• <br /> Owner's Nome . . ...._ Q�(. ....... <br /> Address �- �' 'x•. --•-��1 q. , .� TM= " ._..... <br /> h <br /> ... City . _ <br /> Contractor's Name ............. .. ....� -- <br /> License #.k:� .- .. Phone . . .�... . <br /> installation will serve: Residence [ ,Apartment House] Commercial ❑Traller Court 10 <br /> }Motel ❑Other ...............•-----.._._..-----------•---- <br /> Number of living.units:-_. __.... Number�.of bedrooms _...._ ..:Garbage Grinder .:_... _ .__ lot Size ...9.` ••- * <br /> Water Supply: Public System and name ............:....................' !'t ' Private '. ` <br /> - -- <br /> Peat Sand loam Gay loam ❑ <br /> Character of soil to a depth of 3 feet: Sand Silt❑3' Clay ❑ ❑ Y ❑ <br /> Hardpan ❑ Adobe'[] Fill Ai tenial ............ 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 pubc#sewer"is available within 200 feet,) -1/ <br /> PACKAGE TREATMENT [ ) SEPTIC TANK i ] n tSiae.. �_�-...................... liquid Depth -,.1 <br /> 11 No. Compartments <br /> Capacity .!.•��ti---=Type; -:........ ......�Material.s�r=r..r-=• � F <br /> Distance to nearest: Well ......Foundation ...Z10 -•---• Prop. Line .._ ._..-_•.- <br /> LEACHING LINE [ ] No. of Lines ..__._`Y..._..._-,Length,of each line---------.7- -•--------- Total length �� ... .. <br /> ._.._ <br /> De th Filter Material -__.../-(r. v <br /> 'D' Box .---:'------ type filter,Material .. -• --------- <br /> p ..............� <br /> Distance to nearest: Well .-'.": ............ <br /> Foundation -.l._L>.�.:I:..._..... Property Line -..cam. ......:.... I <br /> SEEPAGE PIT [ ) Depth ...... Diameter ......... Number ............................ Rock Filled Yes ❑ No ❑ <br /> Water Table Depth ----------------------.......w........Rock Size ......................... <br /> ..•---- <br /> Distance to nearest: Weil ___Foundation ---•... Prop. Line •••-••-----•--------' <br /> REPAIR/ADDITION(Prev. Sanitation Permit# Date .... ) <br /> Septic Tank (Specify Requirement) � --- . .............. <br /> -•••---------------------------•--..-..------------------•- ----•.._.....-- .. <br /> Disposal Field (Specify Require m ents),.-=---------------•---..-------•--- -------------------•-•---------- <br /> ....................................- -------------­-­---- <br /> ------------------- <br /> ----•--------•-••---- <br /> I ___...._____ ............................... ................. <br /> t <br /> r ---------........ -------------------•----•--•---------------'--............... ....---:-:. " ired --ddit. -• e <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 <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licew <br /> sed agents signature certifies the.following: <br /> "I certify that in the performance of the work for which this permit is issued, ! shalt not employ any person in such manner <br /> as to become subject to Workman's Compensation'laws of California." ----- -� <br /> i C-- .. Owner <br /> Signed ...... ' <br /> -. .................... <br /> Jh <br /> ....... title __...._:._.:.__.:sy ..-._._.. .. .............on owner) <br /> I OR-OEPARTMENT-USE ONLY <br /> � .. <br /> APPLICATION ACCEPTED 8Y •--•-... ....................................... DATE <br /> BUILDING PERMIT ISSUED ... . ............... <br /> .-• --= a� -...::r.: . . .... .. ............... . erg <br /> ... � . .. . . . ... ... <br /> ADDITIONAL COMMENTS . ._ x <br /> - ----- ---------------------- .... <br /> ...---•- <br /> . ....................... <br /> . �.: — <br /> Final Inspection b ............. ..............Date ......... •• ..... <br /> •� � - <br /> JOA IN LOCAL HEALTH DISTRICT <br /> 71723M <br /> .mac raa <br />