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F <br /> FOR OFFICE USE: <br /> OR OFFICE USE: Vol"'APPLICATION FOR SANITATION PERMIT <br /> Permit No.7. _'�OS <br /> (Complete in Triplicate) <br /> -------------------------------- ---------------------- <br /> pate Is <br /> suedfz} -- ---- <br /> ------------------------------------ - <br /> -------_--------------------------------- 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 compliancwith County Ordinance No. 549 and existing Rules and Regulations: 1 <br /> JOB ADDRESS/LOCATION ti-- -- - <br /> jjT - - CENSUS TRACT. <br /> P <br /> Owner's Name-•-- Va.�Lrc -- Yti. �� %... ---`------- ----- Phone <br /> _ . <br /> � ) �iJ City. -tlZ .c ----Zip- <br /> Address------- .C_ V -� <br /> " ------ ---------License #.---�� ` Z� Phone------------------- <br /> Contractor's Name--- ---- . . � -+�Z <br /> -_ <br /> Installation will serve: Residence ❑d Apartment House Commercial 0 Trailer Court El <br /> + '"- t Motel ❑ +i Other_,. <br /> Number of living units;--- __ --------Number of bedrooms-.. -----Garbage Grinder__.__......Lot <br /> _ i <br /> . Size „_-..----'--_----..__._,-------------~.___._:__._._- <br /> ivate <br /> Water Supply: Public System and named --- - _ --- Pr : <br /> ---- <br /> 'i <br /> Character of soil to a depth of 3 feet: Sand ❑ .Silt❑ °Clay ❑ Peat❑ Sandy Loam ❑� Clay Loam ❑ <br /> Y ti - .s. <br /> Hardpan Adobe ❑ Fill Materidl.__ :...__.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 /> a x•45 <br /> NEW INSTALLATION: .(No:septic tank or seepage pit permitted if public sewer is available within 200 feet,) LIJ <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [_1 Size.----'-------------------------------------------------- ----Liquid Depth------- ti---------------5La ' <br /> ;Capacity -Type No. Compartments-=--------------------- <br /> -- - ----- . r ; <br /> Distance to.nearest: Well--------=- ---- =- -'--_--'Foundation-=------ ----€::_.Prop. Line-:-------------------- -=- <br /> T e._ == Materia =-----:- <br /> LEACHING LINE; [,] ., No. of-Lines_=- _�,,,Length of.each:#in®�: - ----Toto.l.,,Length------_- --------------- ----=- <br /> D' Box-.--- ----Type Filter Material" Deth`Filter Materia_l_!,---------------------------------------------------- -- ' r <br /> Distance to nearest.• Well----------- <br /> -.,-__. __Foundation_.--- --------- <br /> - r <br /> - - -- - ' _ i H--'---Property oper <br /> ty L�ne � , <br /> -- <br /> SEEPAGE PIT Depth-.--' - Diameter- ------ ---- ---Number-r-:------ : � -------- Rock Filled 'Yes No <br /> ❑ <br /> ' ----•--------------------.. F tio ----- - Pr,--- Line ---------------------------- <br /> n <br /> Water Table.Depth - ---._-_ <br /> .. w <br /> V Rock size l <br /> .. <br /> r .Distance to nearest: Well- ---- ---- ounda 'h op x <br /> ------------ <br /> REPAIR/ADDITION (Prev. Sanitation Permit#------------- ------------ ...... <br /> ---- Date------,..-------------------------------------1. y <br /> SepticTank (Specify Requirements) ---------------------- ------------------------------------------------------------------------------------------- --- ------------------ --------------- <br /> 7]7- <br /> D <br /> ------------r <br /> Disposal Field (Specify Requirements} , _.. C � ' : % x- <br /> it - i --- ----------- ---- ------ <br /> --- x: <br /> - - <br /> =------------- ----- -------------- ------------------------------------------------ ----------------------- ------------ -- - ------I--- ---- <br /> ' (Draw existing and required addition on reverse side) <br /> hereby certify that l have preparedthis.application -and that-the work will be-done in accordance with San Joaquin .County <br /> Ordinances, State Laws, and Rules and Regulations of the Sart Joaquin Local Health District. Home owner or licensed agents <br /> y signature certifies the following: .k s <br /> "I certify that in 'the performance of the.work for which this permit is issued, 1 shall not employ any person in such manner as <br /> to become subiect.-.to Workman's Com nsation, laws.of California." 4 <br /> 9 ' <br /> t _ <br /> Owner <br /> Si ned. <br /> _ - <br /> By <br /> -- --------- <br /> (If other than owner) <br /> 'FOR-DEPARTMENT USE ONLY' <br /> I' "`' -- »} - <br /> --------DATE ... .f`�U�-- -------- ------ <br /> � PONAPTED B :_ _ _---/ _ -VSION OF LND NUMBER:------_--- - -------------= -- - -- -----=--:---W. ------------------ DATE.:------------------ ------. . .. --.--- <br /> ADDITIONAL COMMENTS----- -------------`- - - ------------------------------------- ------------------- -------------=------ -- <br /> i---- ----- -----------------------------=------------- ----- <br /> - ------ ----------------- ------- <br /> ----- --- -- <br /> . S _ .� - ----_-_�--------_____ ______ <br /> _--_ --- <br /> _---._-_ ---------------------------_--------------------- ------------ <br /> Final <br /> __________. <br /> Finai-Inspection - - ---- -------------w-------------------- Date -------------- <br /> EH 13 24 AN JOAQUIN LOCAL HEALTH DISTRICT Fas 21677L:v <br /> f' <br />