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FOR OFFICE USE: <br /> f v APPLICATION FOR SANITATION PERMIT <br /> .......... ...... ........ Permit No. 7....:.............. <br />:....... ., �:�L� _ _ ...T. (Complete In-Triplicate) <br /> This Permit Expires 1 Year from Date Issued Date 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 Ordinance No. 549 and existing Rales and Regulations:JOB ADDRiiSS/LC?C IQ� �38� "l -.......- -•• - -- -��T'4f............CENSUS TRACT ----....................... <br /> Owner's Name ... ......... ... ------ -_ --- . Phone <br /> Dq .0.6 8 <br /> Address P 1 .. City •....--- ..... .. - - <br /> ��. <br /> AA .f <br /> Contractor's Name �~�-_G?`a-•-------•--- ...License 0 ��V__- Phone ' <br /> r� --•• .._....-•-- 3 - <br /> Installation will serve: Residence MApartment Housef] Commercial oTrailer Court ] <br /> iMotel Other--------•----•---•----.-. ................ i 1 .......... <br /> I � <br /> Number of living units:-__1-J --- Number of bedrooms ----Garbage Grinder ......... . Lot S ze ` - -. <br /> Water.Supply: Public System and name'-----------•--------- 4..._...__..---------•-•_....:....................................................Private <br /> Character of soil to a depth-of-3- -feet. --Sand-m—-Silt-) " Clay-o—Peat-o Sandy Loamo]T"�1cy Loam g <br /> Hardpan 0 Adobe Fill Material ............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 /> x, <br /> NEW INSTALLATION.' (No septic tank;or-seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGIr TREATMENT [ } SfRTIG TAMC' ` ite. _ ............................... p#I► <br /> Liquid. De <br /> j' 44f_..: 'Z ....... <br /> Ccipaci f �_._.._. Type; Materia) -----•--•----- -._.. No. Compartments , <br /> r �� '�* '_-.Foundation <br /> _/nearest Well „l.B ......... Prop. Line -.---6 <br /> -- -- <br /> I«EACHING UNE No. of.Lines .-.. /--•-.--_-__-- Length a reach line---.O.. --- Tatat L�� ---�7©•�--.._... <br /> . <br /> ' �` A.__... Type Filter Material, . Depth .Filter Material <br /> D' Box_. =�! yp �� ' <br /> / � • <br /> Distance-to nearest: Weil... . :.---.-.... Foundation _..... .. Property Line ......10...... ..... <br /> SEEPAGE PIT Depth ----... Diameter,33.�-.. Number .._.. �-•---_--_--_- Rock Filled Yes � Na �] � <br /> Water Table Depth ....�1.-._._.................. .Rack Size <br /> Distance to nearest: Well ,lcQ �-_:_ �` Foundation :_s .�..!.,.. Pro Llne .. <br /> REPAIR/ADDITION(Prev. SonitatioB Permit •.. Date ) <br /> -•- ... - ......__ <br /> Septic Tank (Specify.Requirementij .-_---------_---------------•....... ................................. <br /> - ........•.. ........-----......_.. . <br /> Disposal Field (Specify Requirements) _----------_--_-- N`- ............ <br /> ------------­------- -------- -.---------------- <br /> ................ <br /> ----------------- ------- -----=---------------------- ------I-------------- -------------------- <br /> ...... <br /> "r1(Draw existing anct requirddi#ion 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. i <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local'Healtit.District..Homo owner Or licen- <br /> sed agents signature certifies the following: � <br /> "I certify that In the " erformance of the work for which this permit is Issued, I shall not employ any person In such manner <br /> as to beco a subjec t Workman's Comp nsation I s of California. <br /> wner <br /> Signed + � <br /> ..(Ifother than owner) <br /> -. . FOR DEPARTMENT USE ONLY <br /> �M <br /> APPLICATION ACCEPTED_BY-y <br />€ _ DATE _-: :: •�1.... .. .. <br /> BUILDING PERMIT ISSUED -------------- - -.------_-_..__.. -----.----. <br /> ADDITIONAL COMMENTS ..---$� , . OAC_.:. ...._ _ _ ._7.G_.-... <br /> .. �,f ..-.---- <br /> -. <br /> f n Date '� �- <br /> ::_:: <br /> Fina! Inspection by: . Z-: . ........_.. <br /> EH 13 24 1-68 1k-,v. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 874 3M <br /> t <br />