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FOR OFFICE USE: <br /> APPLICATION>FOR SANITATION PERMIT <br /> Permit No. .7 S / <br /> 'Complete in Triplicate) <br /> - ------------------------------------ <br /> ` <br /> --------------------------------------------------------- This Permit Expires 1 Year From Date Issued <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 /> described. This application is made in compliance with,.Count-Ord-inance,,No. 549 and existing Rules and Regulations: <br /> 12 ca T {. <br /> JOB ADDRESS/LOCATION _.l-�-u!'! r" ri 4 Q <br /> +a` %:CENSUS TRACT "_ p�U r <br /> �S <br /> Owner's Name ------ r ,. �-"�' ---------------------------=- ----------- ------Phonez.`1 <br /> Address �0 � _ ------------------------ City .: ---------------------------------•-------- <br /> Contractor's Name -. `QRI _y__ "! '------------------------------------License # Q?- / ---------- Phone _V----- 7------•-- <br /> Installation will serve: Residence ❑ Apartment House-E] Commercial Orailer Court ;❑ <br /> Motel ❑ Other -------------------------------------------- <br /> Number of.' i'ving units:------------- Number of bedrooms ------------Garbage Grinder ------------ Lot Size -------------------------------------------- <br /> Water Suppfy: Public System and name -------------- ----------------------------------------------------------------------------------- ----------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam .FJ <br /> ` Hardpan ❑ Adobe ( Fill Material ------------ If yes, type ____________________________ <br /> (Pfo plan, 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. --_A--------------------------- Liquid Depth ---. . ___.....-..._.... <br /> } <br /> Capacity 1c raJ , Type _4G1__-___ Material_CQ&4--------- No. Compartments <br /> Distance -o- nearest: Well ------------------------------------Foundation rf_ Prop LineSi <br /> ------ <br /> LEACHING'LINE, -No, of Lines --------- _____...___ Length of each line-------- __'t__-_______ Total Length <br /> V , <br /> g D' Box ..__._______ Type Filter Material Depth Filter Material ------- _ _____________-_-_._.:__._._. <br /> Distance to nearest: Well ______________________"_ Foundation _Aq_�._______._- Property Line ........... O <br /> SEEPAGE PIT d Depth __- Diameter _____ Number ---.___ ------------_ __ ._____- Rock Filled Yes No .❑ a� <br /> J// arta �� f. <br /> Water Table Deptb-,..�-.:__. : .:_ -:�r :-----_ ;-.:F---Rock Size Ifar---- ---- ------- <br /> I Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit s# _____"__._.______ -------------------------- Date -------------------------- -) <br /> ,. i <br /> Septic.Tank (Specify Requirements) -------- -----------------------------------------------------------------------------------------------=------------------------------•---- <br /> C.ya <br /> •,. Disposal Field (Specify Requirements) ------------------------------- ------------------------------------------------ <br /> ------------- ---------------------- <br /> r` —- �°^i, ---(Draw existing and-required addition on-reverse-side)_.--. r - i <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.SanJoaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> 1 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 ------------ --------------------- ------ Title - ' <br /> ! of r han owner) <br /> F ENT USE ONLY <br /> APPLICATION ACCEPTED BY --------- --- ---- - - - - ----- ---------------------------------------------- DATE ---- ------------- ` <br /> BUILDING PERMIT ISSUED -- -------- -- -- ----- ------ ----------------------------------=--------------DATE <br /> ADDITIONALCOMMENTS - ------- ----- --------- ------------------------------------------------------------------------------•--------------- <br /> ----------------------------------------I--- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------ <br /> ----------------------------------------------- <br /> ---------------------------------- ---- <br /> ------------;------- <br /> FinalInspection by: . ----------------- -----------•------------ --------•-------------------------------------- .Date - --���---�----------- ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 "1-'68 Rev. 5M Cf—, <br />