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7-7 <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ----------------------------- Q Permit No: <br /> ---------- <br /> --- --------- (Complete in Triplicate) <br /> Date Issued 3=_.Z�:_� L <br /> --------------------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION TCENSUS TRACT <br /> t <br /> 7 - <br /> - - " <br /> Owner's Name -----/ffGm------- te. ------ -f --- - ---------------------------------- - ------------ -----Phone ------------------------------------ <br /> Address l 0--l�tY ��?�----------------------- -------------------------------------------------- <br /> --------------------------------------------•--. City ---- ------------------------------------------------•------ <br /> Contractor's Name _ rt v -------------------------------------------------------------------License# ---------,--------------- Phone .............................. <br /> Installation will serve: Residence ❑Apartment House❑ Commercial[]Trailer Cavrt <br /> �/ Motel [-]Other -------------------------------------------- <br /> Number of living units:__=,1__-___ Number of bedrooms .?-------Garbage Grinder ------------ Lot Size 'c' <br /> - ----------------- <br /> Water <br /> - - ---------Water Supply: Public System and name -------------------------------------------------------------------------------------------- --------------_..-Private <br /> Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam 1 <br /> HardpanX 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 /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer isavailablewithin 200 feet,) * �. <br /> PACKAGE TREATMENT [ ] SEPTIC TANK* Size ___�}r®_ j'_---_.________ Liquid Depth __r�._ ..____..____ <br /> Capacity______.__ Typ -___' .__ Material___ ----'"---------- No. Compartments 4!.................. <br /> ................. <br /> Distance to nearest. Well -__________________-_______----Foundation ______________________ Prop. Line -_- ------------------- <br /> LEACHING <br /> _-- ______----_LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length ---------__................. <br /> 'D' Box ------------ Type Filter Material ____________________Depth Filter Material ________--._________ ....................... <br /> Distance to nearest: Well _---_-__-__-___ ------- Foundation ------------------------ Property Line ........................ <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number ___--__-__ ----------------- Rock Filled Yes '❑ No <br /> WaterTable Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line ...................... <br /> /ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ______ ._.------------------------ <br /> Requirement <br /> -__-____-_-__-- ---_ ,F <br /> Requirements) -------X'---'- - - -- .................... <br /> ��� / -- ----+ ------ f ` 1 <br /> DisposalField (Specify Requirements) -----------------------•------------------------------------------------------------------------------------------------------------ <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------=------------------------ <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 with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "1 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 beco ubject t or n's Compensation laws of California." <br /> Signed - - -------------------------------- ---------------- Owner <br /> BY ----------------------------- ------------------------------- Title -------------------------------------------------------------------- <br /> f other than owner) <br /> FF�OR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --- - - �t`40e-------------------------------------------------------------------- DATE ,t` ��/------------------• --- . <br /> BUILDINGPERMIT ISSUED ----------------------------------------------------- ---------------------------------------------------DATE ------------------------------------------- <br /> ADDITIONAL COMMENTS - -------- --- ----- - ---- <br /> ------------------------------------------ .------ <br /> -------- ----------------------------------------------------------------------------------------- --------- <br /> FinalInspection by: ----� ------- ---------------------------------------------------------------------------Date =---- -------------------- ----------- <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />