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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT <br /> Permit No� 7 <br /> ....................................................... (Complete in Triplicate) <br /> ......I............ ........................... ....... Date issued/m. <br /> ... This Permit Expires I Year from Data Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinonce No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION •--; SP, •-/l/!G?l�,e ✓� � .......•...__CENSUS TRAGI ...................I--•... <br /> ...:��y.. .. ... _ .. .........-- •,......--•............................Phone ................................... <br /> Owners Namei' Lr4�N.................... ..............: .. <br /> Address ....... �!• •..... <br /> r� / �� tlL'.... -. .. . City .. <br /> Contractor's Name --- 1-VSl_C. 7`•`....license #l 7� ••:-- Phone��,�� �•• ••••••• <br /> Installoticn.will serve:- --•Residence-{RAoortment Houseo Commercial []Trailer Court 0 <br /> g Motel ❑Other <br /> i g ,IYcz. Lot Size ..�1�-:aC.�� ................ <br /> Number of ,living: units:-..�...---. Number of bedrooms :._ .......Garbe a Grinder ❑ <br /> s ppPrivate <br /> Water Suly: Public System and name :. ........................... .•-------.........---•--.......-----••--•--------. ....... <br /> to <br /> Character of soil to a depth of 3 feet: Sand}] Silt❑ Clay C] Peat❑ Sandy Loam fl Clay Loam❑ <br /> ! t Hardpan ❑ Adobe Fill Material ............ If yes,type ............................ <br /> (Plot plan, showing size.-Of,lot, ;location-of system jn,relatlon. to .wells, buildings, etc. must be -placed an reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 204 feet,) <br /> ... Liquid Depth <br /> PACKAGE TREATMENT [ I SEPTIC TANK{ 1 Size..............................•.--......----- ,..... <br /> Capacity' r........ Type Material..................•••• No. Compartments ...................: <br /> Distanceto`nearest: Well .............°.. Foundation ...................... Prop. Line ...................... <br /> No. of Lines Length of each line............................ Total Length ....._..........._. ........ <br /> LEACHING LINE [ 1 •----...-•.............• <br /> D' Sox ...." ....- Type Filter Material ` ..Depth Filter Material ...............................•............ <br /> 'F <br /> Distance"t, nearest: Well ....:.!.. Foundation ........................ Property Line ..............I'-....... <br /> Diameter tuber ............................ Rock Filled Yes No <br /> SEEPAGE PIT [ j Depth .: --:.:...-:_. ...... <br /> • Water Table Depth ............................. <br /> :.......0 .....Rock Size ............................... <br /> r' <br /> Distance''to nearest: Well.................:.......................Foundation .................... Prop. Line .............. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# - ••.... <br /> --•..... ...................... . ...... Date ........._.............._... 1 <br /> Septic Tank (Specify Requirements) ........................................ ........................ <br /> .- ... <br /> 1 h... <br /> f ............... <br /> Disposal Field (Specify Requirements} •------- -----=---l/ <br /> .{ <br /> ........... ....... <br /> --•--- <br /> ........ ..................•-------........- .,....................................... <br /> ..... _.-.. <br /> {Draw existing and required addition on reverse side} <br /> F I Rhereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, arnd Rules and Regulations of the Son Joaquin Local Health District.Home owner or licen- <br /> sed agents signature certifies the?ollowing- F <br /> 0li certify that in the performance�af the work for which this permit is issued, I shall not employ any person in such manner <br /> r as to become subject to Workman's Compensation laws of California." <br /> Al <br /> Signed .......................................... . . . ... ..•. <br /> Owner <br /> • Title .................> <br /> By .............. ....... k .......... . ;.-••-----.....--- <br /> (If other than ow a;j . <br /> FOR'PEPARTMENT USE ONLY <br /> E DATE ,.lP.. . .Z Y..----_. ........... <br /> t APPLICATION ACCEPTED-BY 6' ..............•--......---. ...... . <br /> :... <br /> BU{LDING PERMIT ISSUEb- Y' .........DATE ........---........-•----•---- .....••. <br /> --••----- ... --•-•--=--------------- <br /> ADDITIONAL COMMENTS _ ......_......-...-•--........I...............•... <br /> 1 ... .......................................... <br /> .'-........F...-----•-'----- .............iA......_...................._...•_ .........................._.......--.............-.._.......................__..... <br /> . .. <br /> ........... ._.... �' ..�-. .......... <br /> ..•--- <br /> :. ::: ` = ......... 1...... <br /> k Final Inspection by: .............•--•---....-----.......- <br /> Date x ..... ........._.... <br /> SAN JOAQUIN LOCAL HEALTH I DISTRICT „ <br /> 7/72 3-H <br /> 13 24 ,_��Q o-- KAA <br />