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"�—FC3R OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Hermit No,7.<---'��•• <br /> ................................••--.............-..... (Complete In Triplicate) <br /> ..................................._..----- - Date issued /Q�.2s <br /> � x <br /> + This Permit Expires I Year Er m 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 Ordinance No. 549 and existing Rules and Regulationsi <br /> JOB ADDRESS/LOCATION .-... ..1.1 y.r�.....--.-.Ir�. .....- _;:t_2 ..........................CENSUS TRACT .....-......._..,,........ <br /> i <br /> .. - .. .. <br /> { l <br /> Owner's Name � ..........ersz- ......-•-•-• ...............s.,....-.�.. ...........................Phone ....... ............:...__...... <br /> city,.:.................................................. ......_ <br /> Address ------------------..A ... t <br /> Contractor's Name .. ------ ` -------- _... _-j.... <br /> License # -7/. •s' it-- Phone ��G•�: 6 <br /> Installation will serve: Residence aKpartment House 0 Commercial OTroller Court 0 <br /> Motel ❑Other -_-. I <br /> � � a <br /> �+ J4 =w " <br /> Number of living units-------/____ Number of s L-•...Garbo a Grinder rif'.i___ Lot Size . _-.-X---�••-- <br /> �Lf". `` - ..•••.,. r.:Private ❑ <br /> Water Supply: Public System and name -----�?jloo <br /> --•-------•=- <br /> Character of soil to a depth of 3 feet: Sand b Silt Q Clay . Peat❑ Sandy Loam ❑ Clay Loam <br /> Hardpan[,3 Adobe Fill Mnterlal�r- <br /> ... ... if yes;type <br /> (Plot plan, showing size of lot, .Io`Ication of system in relation to wells, buildings, etc.-must bei placed on reverse side.? <br /> 'NEW INSTALLATION; (No septic tank or seepage it permitted if,p`ublic sewer is available within 200 feet <br /> PACKAGE TREATMENT ( ] SEPTiC TANK ,6 Size....._-7'.�>-_d -•----•-•--.... Liquid Depth ....-��---•••� <br /> capacity TYPe --- partments ---._ . -.•---_---••f <br /> :- J <br /> om <br /> Lance to neare t: Well .......,n1l - Foundation .. �......-. Prop. Line ---••-- -••---- <br /> x <br /> LEACHING LINE [ No. of Lines ----------------------- Length of each fine------ ... Total Length - -Q.`�----........• <br /> '�- -- '�,� J � ars <br /> 'D' Box 4VY.. Type Filter Material -..-,........Depth Filter Materi `,./J--..........•-..........----••••. b <br /> Di.stance'to nearest: Well ---- ✓ll�...... Foundation ....�.P............. Property tine ----._............� <br /> I `, 1 1 <br /> SEEPAGE PIT ( ( Depth ----J•.�--.. .. 7 <br /> -Diameter ...._.:._Rock Filled :. .Yes No �} <br /> x---� Numbed.- -----._. .---�-� <br /> �--�-�- - Rock Size _--- <br /> � J��.� �( Water Table Depth,.....,...,-6.�------------ --• • <br /> I II <br /> ...... <br /> �---Foundation -----�-- -s...... Prop. Lln <br /> a ...S...`..!... <br /> ..........Distance to nearest: Wel! ------------ -------- <br /> I <br /> Date ----•-- -------; -REPAIR/ADDITION(Prev. SanitationPermit# ........-_-•... . .................... <br /> ) <br /> Septic Tank (Specify Requirements) ----'.. ..........-................. .......:........................................................ _.........--....._. .. .......----.. <br /> I --...... <br /> Disposal Field {Specify Requirements) ...---..----••-•--•--------------.. ..i-----------••--••--•--------------...---•............................................ <br /> I .....----- <br /> . - i <br /> •--•-- ------------•---•------------------- --------•-------------•-,- -....------..-------- <br /> :, ._------------- --------'___.............................._----- __- <br /> (Draw existing and required addition on reverse side) <br /> I .hereby certify that I have..prepased this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner of licen- <br /> sed agents signature certifies the following:# <br /> "I certify that in the performance of the work for which this permit is Issued, I shall not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ---------_---•------ .................. .. --------- Owner b� <br /> By - --- ------------------------ -----, Title .... ----------_-----•- ' ...------ <br /> (If oth an owner) I I <br /> FOR DEPARTMENT i JSE ONLY <br /> ------------ <br /> APPLICATION ACCEPTED BY ........ ........................._ <br /> . DATE ./ :n�-�S BUILDING PERMIT 155LiED ................ -.:..-.._.-_DATE -.... <br /> ADDITIONAL COMMENTS ------ ---- ....-.--.....-- - = <br /> -------•--•................ -.. ----------- ------ ------......-..-..------------- ------ -----.............. <br /> .,p 1 .. 1. .� t /-. - <br /> -..... = ----------------------------- .. <br /> \ t > �.. +. <br /> ......... ......... .. <br /> -. <br /> Fina! Inspection bY: Date --..�............. ...... .. <br /> ------------ / ; <br /> EH 13 A 1-68 V. SAN JOAQUIN LOCAL HEALTH DISTRICT � � - 8/74 3M <br />