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" FOR OFFICE USE: <br /> APPLICATION FOR SANITATION .PERMIT <br /> �......................... .. ... Perm(! No. 7,�-��_� <br /> (Complete in Triplicate) <br /> ............................ ... `.... This Permit Expires 1 Year From Date Issued <br /> .. ....... <br /> Date Issued ._. . <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> r <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> i <br /> (T <br /> JOB ADDRESS/LOCATION ... a?.F-.9. ...... ...4&_ � . .CiNSU5 TRACT ..............:........... <br /> 1 Owner's Name _ .-•# L/ rrrl - `n a7- '-'°',• •�1. ....._..-- Phone ,T 6.�.}.��/L.�.. <br /> Address ...................7 : �`73... --.��...... - <br /> Js-- .... tY / ::........... <br /> Contractor's Name .......-....�- •- _-- -- --_ ................License # Phone .. ..(a. .............. .... <br /> Installation will serve: Residence)KAportment House Commercial ❑Trailer Court ❑ <br /> Motel [k Other _ ... l� .r._�_........ <br /> Number of living units:............ Numberof bedrooms ............Garbage Grinder ............ lot Size .... !>............-------- <br /> ... _._....�: ...,_��-�-ter <br /> Water-Supp ly:`PubIic System�dtid'Warne : ..... - - ...__....._... ..... .....I.......----•-------- -----PrivateA <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ " Peat❑ Sandy Loam fl Clay Loam-.0 <br /> Hardpan ❑ Adobe ,Q Fill Material ............ If yes,type ............................ <br /> {Plot pian, 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 is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'( ] Size_________________.................................. quid Depth .......................... <br /> i <br /> Capacity ----- Material............. No. Compartments <br /> Distance to nearest: Well ....................................Foundation------------------------ Prop. Line ...................... <br /> LEACHING LINE [ ] No. of Lines ------------------------ Length of each line..----------------- Total Length _..._.._.. ................. <br /> i D' Box Type Filter Material _.Depth Filter Material ......................................... <br /> l Distance to nearest: Well ............._---._.._ Foundation ........ ............... Property Line <br /> F SEEPAGE PIT ( ] Depth <br /> . .. Diameter -----•----...._. Number ---------------------------- Rock Filled Yes ❑ No ❑ <br /> Water Table Depth ......:.:........... <br /> ' --••------------------------Rock Size --------------------- <br /> Distance <br /> -- -------------........---- <br /> 4� <br /> Distance to nearest: Well ........................................Foundation -----._ ............ Prop. Line ..._... ............ <br /> r REPAIR/ADDITION(Prev. Sanitation Permit# ...._'....................................... Date ................................-.) <br /> ,, _ -----•.............. <br /> Septic Tank (Specify Requirements{ .:..----.'•--•....----------- ...--......................................................................... ........ <br /> Disposal Field (Specify Requirements) -------- ---4 ....... ...... . -f��' .:__.sf_ 3__� _._. ----- . __.......-- <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 Loral Health District. Home owner or <br /> licen-sed agents signature certifies the following: m <br /> °"I certify that in the performance of the work for which this permit is.issued, 1 shall not employ any person In such manner <br /> as to become subject to Workman's Compensation .laws of California." <br /> Signed ... ...........................:. C <br /> . . . -•---•---•--:.......---_. Owner" _71 � --•-- .Title ���( . ..--•----- <br /> By ............... .... .Ver <br /> . ...._...., <br /> (if oh wner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED B :............•----------...-----...----._....--- ....... ......-•--••-----••• DATE ............... <br /> ..�^`... ....................... <br /> .7 ...----...... <br /> BUILDING PERMIT ISSUED .............:..:........................... - ..............................DATE <br /> ADDITIONAL COMMENTS <br /> ....... <br /> .............................-......................... •---._..... ------- <br /> .---- - •. ----- . /---.--.lx.--.-. :....,... _ _ ........--••-•................ •-- •-•--:... : "- 7 .........._. <br /> Final inspection by: ... sze�. ..�A.. :.... ......�- .....-=-•_-• -._..1............................-•--•----.Date ....�1 ................ <br /> ................ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> v 13 24,_-,cc oe xu 7/72 3-M <br />