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r: 7R _t USE: APPLICATION FORSANITATION IsIrRAh1TPermit No: --7?•~-/ •.. <br /> ............ ICorr+pleteirETr;pl;totalD ate Issued.-... This Perrt�it IExplrss 1 Year Front Da..... Health <br /> D Ordinance No <br /> .t <br /> ith C Y . 549 and exiting Rules and Regulations: <br /> App' <br /> lication,is hereby made to the San Joaquin Local Wealth District for a permit to construct and install the work hatein <br /> PP lication is mad' in compliance <br /> described. This app <br /> 3 .......J: fJ.......GI.7..=................CE TRACT ... ...................... <br /> CENSUS <br /> ,JOB ADDRESS/LOCATION .. ...... ......_... <br /> ... <br /> Owner's Name ............. ... .......,.................................................. <br /> , <br /> 4. �:L. _ _._ ,� City .............. .. <br /> Address . . ... .. Ph <br /> ��.........._.: License # <br /> . , one <br /> Contractor's Name .... <br />` installation will serve: <br /> Residence(9-Apartment House 0 Commercial ❑Trailer Court Q <br /> E Motel Q Other ............................. <br /> 3 Garbage Grinder <br /> ............ <br /> Lot Size ,1..-- ............. <br /> Number of living units:-----y- Number of bedrooms - ----•- <br /> _....................................................Private r❑i. <br /> Water Supply: Public System and name ................. ............... Sand Loam Q Clay Loam ❑ <br /> � ❑Character of soil#o a depth of 3 feet: Sand's Slit 0 Clay ❑ Peat Y •...,.•'.-,. <br /> Fill-MoterIoIl .......:If yes,type ............... <br /> Hardpan Adobe-[] . <br /> l buildings, etc. must be placed on reverse side.) <br /> (Plot plan, showing size of lot,'location of sys4em in relation to well's, <br /> No septic c tank or seepage pit permitted if public sewer•is available within 200 feet,) <br /> i NEW INSTALLATION: ( p �� .. Liquid Depth .......................... �1 <br /> r SEPTIC TAMC�']� f Size-----------------:............................ YJ <br /> PACKAGE TREATMENT [ ] - ::Material.......:.::-:µ:..... No Compartments s <br /> ...................... <br /> Capacity _--------- pe.-•--=----....----_.. <br /> E .Foundation ..... Prop. Line ...................... <br /> Distance:to nearest: Well ................................... <br /> j ............................ <br /> } ---._ Length- of each line..................:.:..:.... Total length <br /> LEACHING LINE [ } No. of Lines Z <br /> ' ;� .Depth Filter Material ................................ ...... , <br /> D' Box <br /> Z.... Type Filter Material ......._...,._ <br /> !; Distance too nearest: Well ........................ Foundation ......................-. Property Line ..... y <br /> :..:. Number Rock Filled Yes ❑ No Q <br /> SEEPAGE � ) Depth l Diameter p <br /> ----•---------•-- <br /> cc Size <br /> ble Depth ...-•Ro <br /> Water 166 <br /> . <br /> Distance•to nearest: Well ----------------------------------- <br /> Foundation ._ Prop. Line ......•••....•.... <br /> ' Date <br /> REPAIR/ADDITION(Prev. Sanitation Permit --••--....... <br /> .'iIT.............•-.....----•- . ............ <br /> Septic Tank (Specify Requirements). . <br /> Disp sal Field (Specify 'liequirements) ..__..-- - " .. . ..-----._ .... <br /> II.: ..__..:----------------- <br /> 1 --- <br /> ----•----- <br /> _... •--------••.................I..._...._...... ..... ............ <br /> ..... <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 �wlth San Joaquin <br /> County Ordinances, State Laws; and Rules and Regulations of the Son .Iaaquln Loco! Health,District. Home owner Or lien• <br /> sed agents signature certifies the following: arson in such manner <br /> "I eertify that in the performance of the work for which this permit Is issued, 1 shall not employ any p <br /> as to become subject to Workman's Compensation laws of California." <br /> : <br /> Signed ---- --------•--------------------------------- - --------------- - --------------- Owner ------�- ------ ...... <br /> By - (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> . <br /> ...........DATE _.,. :._. -----•- ------ <br /> . APPLICATION ACCEPTED BY -i.-�-�-....----- �- ......... ._-.-._..-------- ---- - ....DATE ....._--- -............................. <br /> BUISSU ... <br /> i LDING PERMIT IED _.._ _. ----------.-•-------- --•-........__.--------- ------ ----_ <br /> ADDITIONAL COMMENTS .... ............................................ ........_-----... <br /> -----------•------ ----------------- -•---•--• ----...--- <br /> --------------•-•-- --.... ....................... ..--- ..1 <br /> .....------ ..._.... <br /> - -----------------------------------•---- ------ <br /> I _... -- <br /> --- Date .t1.� ...2 ........... <br /> FinalInspection by: -------------- ••- ---- -- ------•--------.................... ............._...------------ <br /> EH 13 24 1-69 Rev., 5H N JOAQUIN LOCAL HEALTH DISTRICT 8/7)i 3M <br />