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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. 7� 07.3 <br /> (Complete in Triplicate) <br />_._._ ....................... <br /> This Permit Expires 1 Year From Date Issued 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 /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS%LOCA�R : s ' Regulations- <br /> ...-,.-..CENSUS _-. ":::_.. : �: <br /> Owner's Name � ...�_.,_ / _.. <br /> Address".:_.:.: .. >� ..-Phone ...................... <br /> ho <br /> / gi !mac/.r ,-.t -..City ��` ��-. ....... .... . . <br /> Contractor's Name "'t-t-�".:.- -�- :j - iaiceri'se # 3c . Phone:.:...::..::.. ..........:..... <br /> 1,6 <br /> .G ~� <br /> Installation will serve: - Residence partment House -Co: mm ercial-E]Trailer Court,—❑; <br /> ..Motel ❑.Other:::.:.:...'::•::-:,-y:; __•:_: = = .. <br /> Number of living units: N <br /> ,..,-:�.,_..,. . qmber,.oi, bedrooms_,- __:=Garbage..Grinder :,..__.:..__,Lot Size :.._.__ -...._!.. <br /> Water Svpply: Public System and name ..-• ;:. ..:......:....•-:•-• - rivate l .,� <br /> Character of soil to a depth of 3 feet: Sand5ilt Clay, Peat Sand Loom Clay Loam ❑ <br /> p ❑ y ❑ ❑ y, <br /> eN <br /> .... <br /> Hardpan E] Adobe [] Fill Material If yes:type .-- -....---- q <br /> [Plot plan' showing size df.,lot, lotation.,of system m 'relation to .Wells;.,bU'ildings, etc.-r.MUO .be .placed on reverse;side:I <br /> I : r <br /> NEW INSTALLATION: ` (No septic ;tank or seepage pit permitted if,:pvblit•sewer:is avai-Iable�witHin,200 feet,[, <br /> PA <br /> Size CKAGE',TREATMENT [ } SEPTIC TANK l } -- Liquid Depth _ ' <br /> ...}. .. - i- <br /> Capoaty '_ Type ------- M6teri: 1 .. .. No Compartments <br /> i Distance to nearest: Well Foundation Prop dine <br /> LEACHING LINE [ No, of tines Length of:each Irne i Total Length' _..._ <br /> `'"D' 'Box eptli'Filter Maten :: .... <br /> Distance to nearestt Well :__:.::. --- Fobndbtkort ::: Property Line ............ .......!_ <br /> SEEPAGE PIT [..) .Depth ... . :... ..::... -Diameter -_-_- - _-- Numiier < Rock Filled Yes ❑L No <br /> Water Table..Dspth._.--_.:_...:._. Rock,Size <br /> Distance to':nearest:;Well ....... ,:-Foundation ..- Prop„ Line <br /> _.. <br /> REPAIR/ADDITION IPrev. Sanitation';Permit# ..__._,, Date 1 <br /> .. .. <br /> ;Septic Tank :(Specify Requirements) <br /> - . <br /> - . <br /> -- :.....-_. <br /> : ...._.,..... ....-.--------i.-0s osal Field (Specify Re virements) : ......................... . :.. <br /> . ...: ... .. -- -- - <br /> (Drawexisting and required addition <br /> , <br /> on,reverse side) <br /> I hereby certify that I have prepared this application and that the. work will be done, in actordarice with: San Joaquin <br /> County Ordinances, State laws, and Rules and Reguiations:of't'he-Spit-Joaquin Local Heitlth'Distriet.'Nome owner or [icon. <br /> sed agents signature certifies the following:.:. , <br /> h "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 /> Signed l F.. "...._ :... :..'Owns <br /> as to become subject Workman s:Compensation laws of'Calirarnla <br /> 9 �. <br /> By <br /> - `,.....: . �`- ..- �P� Title <br /> (If other than owner) ` <br /> FC?R DEPARTMENT USE ONLY _ <br /> APPLICATION ACCEPTED BY ­:.... ._t_. ....:......:...... .....:_ ..._._•__._ DATE /.L, : . ... .................. <br /> v>f. �. <br /> BUILDING PERMIT ISSUED ----- ...... ; - <. .:.. :...DATE _.. -- --------`...... ......... <br /> ...: <br /> ADDITIONALCOMMENTS ......................:..... .... .. ................ = - ----- ............................_......._._... <br /> i' ------.---•------------------- : ----- -----------• < ---------... .• ... _ ------ .. ---------- .............,.......... --------......._ <br /> ..-- <br /> ... -------- •-. Dat Y � ................. <br /> Final Inspection by:. . . .C; - - ;.. = e <br /> ................ <br /> _ ,SAN JOAQUIN LOCAL _HEALTH: DISTRICT,.„ <br />