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LW FOR OFFICE USE: _- <br /> APPLICATION FOR SANITATION PEWIT <br /> Permit No. .7 <br /> 1compiate in Triplicate) <br /> ........................... ...... <br /> ................. ............... This Permit Expires Z Year-From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein <br /> described. This application W-made in compliance with County Ordin.once No. 549 and existing Rules,and Regulciflons: <br /> .�� <br /> JOB ADDRESS/LOCATION ... .........�......�.._,----._,., :_......` :.. .. :...... ...' ..... .. ..............CENSUS TRACT .......--•-- ..._-- <br /> Owner's Name f .aA s .. Phone ..F �?�-- <br /> Address ........ .......�_. . ...- •- --•-••..............._. .. ........._...:City c�. <br /> Contractor's Name _...License\*Z.X5�1;.... Phone _ .� � : <br /> esidence14'Apartment House t~] Commercial)]Trailer Court 0 <br /> Installation will serve: R Motel (]Other......._-• _--_-- <br /> f} 2 ----------------•----_.---- �� <br /> Number of living units:_...... Number of bedrooms 1.,z_....Garbage Grinder .....__ Lot Size L-:`.....(.:l.......................... <br /> Water Supply: Public System andame ,_ . <br /> .. ._.............................-----:..._......................._.................Private <br /> Character of soil to a depth of 3 1etet3 Sand� Silt❑ Clay ❑ Peat.0 Sbndy Eoam Q Clay Loam Q <br /> H span p Adobe l% Fill Material .-. _ ..-..1f yes,-type............:.. ............. <br /> r ! ; <br /> (Plot plan, 'showing size of lot,locaatiori of system In relation to wells, buildings, etc. m st be placed on reverse side.) <br /> NEW INSTALLATION: (No septic to k-or seepage pit permitted if public sewer is available within 200 feet,) e <br /> PACKAGE TREATMENT [ SEPTIC TANK '`+ ize......�'XI.......................... Uquid Depths . --- <br /> Capacity _--- Type �`'� Material.- '_ No. Compartments ------------------- <br /> Distance.to nearest: Well -•..._..._..c2. ` r'..........Foundation .......�a r Prop. Line. ..- f'..... " <br /> LEACHING LINE No. of tines .-.....�? ....__ Length of each ling. �. yea Tota!,L6 th ...�7�_�........... <br /> 'D' Box _�_..._ Filter Material . De th .Filter Material /.-1..- <br /> I]istance to nearest: Well ........................ Foundation ------ Property Line <br /> 00 <br /> r it mit <br /> --- _I - -------- ........._r------------•--•--_Rock Size s 7~ No <br /> SEEPAGE PIT Depth - Diameter 1� .'-.'..___ Number""""' Rock Filled Ye <br /> Water Tat'le Depth <br /> Distance to nearest. Well -Foundation __.. Prop. Line ....................... <br /> itEPAIR/ADDITION{Prey..Sanitation Permit# _____.:.._...---.:.---•-..__. ..-.-_:---- Date --------- .................... .........•} L1 <br /> Septic Tank (Specify Requirements).... ---------------•----••------....................._.:.__. .................--................Y <br /> Disposal Field (Specify Requirements) --------•-----............................................................ ---------------------•---.=-•---••-----------... <br /> -----------------------------------­­..................................­-•--•-•-----• ••--------------------•• ........................ <br /> -------------------------------------•---------- --------•-------- - ---------= -"". ............-----•------------• .................------ ......... , .....-----•--- <br /> (Draw existing and required ' <br /> ddition on reverse side) <br /> I .hereby certify that 1 have prep .red"this applicatlon-�nd !that the'work will be done In accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and ltegulations of the San Joaquin Local Health:District. Home owneror licen- <br /> sed agents signature certifies the following: <br /> r "l certify that in the performance of the work for which this permit is issued, 11 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." . <br /> Signed ----------------- -------- --------• = ---------------------------I---------- Owner l <br /> BY . `....... ....._ ............ . J'itle ----------- --•-- ...... ............... <br /> ;If of r hon owner) <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> DATE .rD•..j-7.J-------•.............: <br /> BUILDING PERMIT ISSUED DATE _ ::.?4 <br /> ADDITIONAL COMMENTS .2 •[ l - ._...__,.. ......:.......:. .............. <br /> ...---- ...... ------------------------------- • -- ...--•- -•-- ---------------...__._.------------------.--------•---- <br /> 1. ' <br /> -- ------•------------- �----- -•-•-------•--•• - ---- <br /> ` _.. ------------------------------ -•----------------..__.......................... �-- , ..... <br /> final Inspection by. .-----....Date ._ ..�1�, �' <br /> ` 13--------------------1-6 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br /> yY. <br /> f <br />