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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT 7D <br /> (Complete in Triplicate) Permit No. <br /> . ........ ........ <br /> ......•... J $. <br /> ... This Permit Expires t Year from Deft Issued Data 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. 544 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATiO !' ....'............... ..............CENSUS TRACT ........ <br /> Owner's Name <br /> ... ----...-- -... ........-. ...........................................,......................Phone <br /> Address ... ...... . ... . •. . ------ -•-• ...............City . ............ .. <br /> Contractor's Name - - --G �`¢'�-°I .................License#�� ..1.: '� .. Phone .24. ._ <br /> Installation will serve: Residence�JApartmont House 0 Commercial OTrailer Court 0 <br /> Number <br /> 0 Other............................................ <br /> Number of living un <br /> its:....._._.. of bedrooms .....3---Garbage Grinder ............ Lot Size <br /> Water Supply: Public System and name ........................................................_-..................................................Private(� <br /> Character of soil to a depth of 3 feet: Sand'0 Silt 0 Clay 0 Peat 0 Sandy Loam Q Clay Loam 0 O. <br /> Hardpan 0 Adobe 0 Fill Material ............If yes,type............... ............ <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, oft. 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 TANKze..................... --.-......... Liquid Depth ....V`�...q............. <br /> Capacity ..�(.. 0 <br /> �._ Ty ----• ...... No.Material.� �G_:..... No. Compartments ..:...:............... <br /> Distance to nearest: Well .Foundation ...... Prop. Line ..,.>... .......... <br /> LEACHING LINE [ j No. of Lines ----..- .--_--- Length of eachline................ <br /> .I............ 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 0 No 0 <br /> WaterTable Depth -----•-------------•--- ........................Rock Size ................................ <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation PeIt# ..... ..... .............................. to .------ ----. _---:_) <br /> Septic Tank (Specify Requirements) �� .__..l%�f.R. •--1r�.-''•�'� ..PZS ., <br /> Disposal Field (Specify Requirements) ................. ..................••-•-•----------.........---------•--......-•----. d.ct ................. <br /> ................... ------ ------------ .......... ---•------------------•-----------•----._...--•---••------..........------............----..........................---------............... <br /> ----------------- -------- -----------------------------------------_............................................................................................ <br /> (Draw existing and required addition on reverse side) <br /> 1 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. Meme owner or licen- <br /> sed agents signature certifies the following: <br /> "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 /> as to become subject to Workman's Compensation laws of California." <br /> Signed ---------------- '---- ------------•----_------ Owner <br /> By ---- ---------_...t -� -• r ------•----------._. a -- -- -- _ ...---------- --•--- --- ...................... <br /> ... <br /> " Titl <br /> (if other a owner) <br /> _ R DEPARTMENT USE ONLY ` <br /> APPLICATION ACCEPTED BY __ .. .. _-. ~_...._ DATE . ------ <br /> BUILDING PERMIT ISSUED ----.... -----...... _....__.... .................. <br /> ------ ..DATE <br /> ADDITIONAL COMMENTS ...... .... .. ...................... _.....------- <br /> - .......- _......................... --------------- ................... ------. ----- ........................ ................ <br /> .......................... ------ .... ...... ----- ...... ,- ---- .................... <br /> -- ......... ............ ................ . .................. . .. ...-.-.. <br /> f <br /> Final Inspection by: .._.._ ,-, ------ Date ....[t/...� ..�fo <br /> . ----- ............... ......... ..... . ... ._ ............... <br /> EN 13 21; 1-6fi Re SAN JOAQUIN LOCAL HEALTH DISTRICT X74 3M <br />