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FOR OFFICE USE: Y .7= , <br /> -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No,.__.7.3_ 7 7 <br /> ------------------------------------------_ This Permit Expires 1 Year From Date Issued Date Issued _7=3gf3 <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 Regulations: <br /> BnerD Name <br /> �,- ------ --CENSUS TRACT <br /> Ow ' <br /> ------------ K-------����- ------------------------------------------------------ --Phone -------------------------------- <br /> Address ----------- <br /> ---------- <br /> '7'-Fi nl',_ r <br /> City .......... <br /> ` <br /> �uvnl� ---------------------------------------------- <br /> Contractor's <br /> Name ---------------j ----------------------- --------License ------- - ------------- Phone <br /> E Installation will serve; Residence (�partiment House Commercial :❑Trailer Court <br /> ff <br /> f, Matey _ ------- <br /> --------- - <br /> Number of living units:__.!__ t^ ' <br /> ____-- Number of bedrabms _3_____Garbage GrinderLot Size ___ <br /> Water Supply: Public System and name ____i_- ____________ <br /> i ---z= --------------=-------- ------ Private [ r <br /> Character of soil to a depth of 3 feet: Sand'❑ ❑ Clay ❑ ,,./Peat❑ Sandy Loam ❑ Clay <br /> ]Loam,: <br /> Ji Hardpan e Adobe Fill,Material __!.� �__ If yes,type _______________ _______ ' <br /> ----- <br /> (Plot plan, showing size of lot, location of system in relati n to wells, buildings, etc, must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seep e-pit Permitted if public sewer is available within 200 f�,) <br /> r <br /> PACKAGE TREATMENT—[I-- •SEPI IC TANK?[ y.' � Size--- <br /> � � <br /> Liquid Dept�t -`�-�----- <br /> Capacity _1.� �7�e f <br /> Yp - ---_-- _ -__ Material_�©�VCT-- No. Compartments• ----- ,_._-- <br /> °stance to <br /> inearest: Well °+ <br /> -______ _________Foundation __f __'+------ Prop. 'ine --- <br /> LEACHING LINE70 , <br /> [ NDo.B X Lines _.___--- ----,.v---- Length of each line_-.----�.�-----__-_-- Total Length x_` --------------­----- <br /> 'D' <br /> S <br /> p -----•------ <br /> 5 Type;Fia'ter Material !�-dC6.___Depth Filter Material e u <br /> rc -----------------------•------ <br /> SEEPAGE PIT De talnc�o nearest; Well-3V-------- FoundationProperty -- <br /> / � �� � -- �------• -- X11 <br /> ,[�f t r i --mac ,Line == <br /> P ---------_-- IJiameter Number -----------��-- �/Rock !ed E Yes No i❑ <br /> Water Table Depth _._ r' -- - 'p �,�=,e"�,,.,;•'�-`-'�"�.R Rock Size <br /> Distance to nearest: Well -._____lQ�_________________0__Founclation < -4— <br /> # �f� op. Line .. -------- <br /> REPAIR/ADDITION{Prev. Sanitation yPermit# _.:�___ _______________ ____---___ Date <br /> ---------- <br /> Septic Tank (Specify.-Requirements) ___.-___.____----. �y <br /> l n= <br /> 1. <br /> Disposal FiOld (Specify Requirements) <br /> ------------ <br /> = - <br /> I hereby certify that I have prepared this application and that the woon reverse side) I ! <br /> [Draw existing and required addit°ori <br /> p p #rk 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 /> yam.. <br /> "I certify ih in the erFoE of the work for which this permit is issued, I shall not employ any person iri such,manner <br /> as to beco sublet to W 's Compensation laws of California."g Owner---------------- n - <br /> ----------- - --- -------- _ _,if_.� Title - - s <br /> -------------------- <br /> (If other than owner} - ----------------=--------- <br /> i <br /> //�'■�{ 'FOR .DEPARTMENT USE ONLY . <br /> APPLICATION <br /> -- • S 4 C ------------------ -------------- ----------------• - <br /> DATE ------ T ----- <br /> ADDIIT --------- <br /> ADDITIONAL PERMITBUILDING OMMENTDS BY <br /> ---- - l F 1 _ _ --------- -------------DATE ----------j--•----- `' <br /> - ------------------------------------- -- " _ - -------------------------------- <br /> ---------------- <br /> - <br /> -- --------------- ---------- <br /> -----•---------- ------------- - ----------------------------------------- ------•-------_----- <br /> r, <br /> i <br /> i <br /> f: <br /> t <br /> �__ <br /> .L- [ _ ___________________________________________________________ <br /> Final Inspection -- - ------------ --------------------------- <br /> - --------- <br /> = --------- - - - -- <br /> Date --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> �. , <br /> E. H. 9 _ 1-'68 Rev. 5M �,,,•;.�� _ � <br />