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` FOR OFFICE USE: <br /> APPLICATION ICOR SANITATION PERMIT No. 7 <br /> (Complete In Triplicate) <br /> Permit <br /> Date Issued <br /> ...........................................I-..._ This Permit Expires 1 Year From Date Issued <br /> Application is hereby mode 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/LOC IONS .......... ........CENSUS TRACT <br /> Owner's Name i z- •...................................Phone .............. ................-- <br />' Address <br /> City .......... .. <br /> Contractor's Name ........ ..?f -c-- --rte :.LicenseLr' Phone. .�C•• �� - <br /> Installation will serve: Residence f Apartment House 0 Commercial OTral ler Court .0 <br /> Motei❑Other <br /> . ............... .......................... <br /> Number of living units:....®._.. Number of bedrooms •.-. ...Garbage Grinder Lot Size -. ..:..... ..........:....... <br />{ Water Supply: Public System and name ............................ ............................-................... •• <br /> .........._..........: .Private[❑ <br /> Character of soil to a deptfiof 3 feat: Sand 0 Silt 0 Clay ❑ Peat❑ Sandy Loam 0 Clay loam <br /> t d�� Hardpan L] Adobe 0 fill Material ............ If yes,type ............... ............ <br /> (Plot pian, showing size ff lot, location of system in relation to wells, buildings, etc. must bplaced on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,( <br /> PACKAGE TREATMENT j ] SEPTIC TANK ] Size................................................ Liquid. Depth .................... <br /> C i1P 'tY ------------- Type --- Material- .... No. Compartments _S <br /> Distance to nearest: Well.................•...----.........:.Foundation ...................... Prop. Line ....................... <br /> r <br /> -11'f LEACHING LINT; [ ]. No. of Lines ---.....�......�.._. Length of each line...A..� .............. Total Length ............................ <br /> oQ <br /> 'Do"E 8ox Type Filter Material ....................Depth Filter Material .....:...:....... . <br /> — tDi "tance to nearest: Well ....................... Foundation ................ Property Line .....:.7......•.......•• <br /> I SEEPAGE PIT ( ( Depth ��--�X.6Diameter ................ Number -------- ................... Rock Filled. Yes ❑ No <br /> Water Table Depth --------------------------•.....................Rock Size ................................ <br /> Distance to nearest:.Well ........................................foundation --------------------- Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit <br /> ............................................. <br /> Date .................................. <br /> Septic Tank (Specify Requirernen#s) -.- -----•------------•---•........................•-•--.......................:.. <br /> Disposal Field (Specify i Requirements) --------------------- •--••--------•------................._......_.........----------.... .. <br /> ------------------------------ -------- .........._.._..............___......_.__.............................---.........•-•--•--....--------- •----......._. ........... <br /> ------------ <br /> ----------------------- .............••--•. -------------------- --.................•-•--- ---._......-----------._..._....._....: .............. <br /> (Draw existing and required addition on reverse side) <br /> r 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:Gistrict. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "1 certify that In the perforliinonce of the work for which this permit is issued, i shalt not employ any person in such manner <br /> as to become ser le o Workma ompensation laws f California." <br /> Signed ------------- --- ••. . - . .....-...... _ Owner <br /> { <br /> By -....,. �I <br /> Title _ ......- ------- ----------- <br /> (if otherthadownerFOR <br /> DEPARTMENT USE ONLY <br /> , h <br /> APPLICATION ACCEPTED BY -------- •...... ..... .. • ---- -------- ---- ------------------------- ...... DATE_-;L/a/ <br /> i BUILDING PERMIT ISSUED!'.. .. .............. DAT _.. -. ..... ............. <br /> f A ..... <br /> DITIQN41- COMMEN ---------- -- <br /> T "i�: 1�_` .....-------------67 ... .- - -------............ . ...4Q._Y1A..�9-Q�a_.... ..._._ a7r_. =p <br /> ``fit �'W <br /> ' ------- -------•-•--------- ! - -- ------------ ...................1-- <br /> -----•----------..._--------- ...------... <br /> ----------------------- -------------- -- --�f <br /> - ------------------------------ ------ -- ............. <br /> Final inspection -----------------Date .-..r.. _.�... <br /> EN 13 2a 1-68 Rev."'5M SAN JOAQI.,IIN LOCAL HEALTH DISTRICT 8/7h 3M <br />