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FOR OFFICE USE: APPLICATION FOR SANT ATI ON PERMIT <br /> - <br /> ------------------------------------------------------- <br /> (Complete in Triplicate) Permit No. -7-1- <br /> ---------------------------------------------- <br /> #11 Date Issued _.9.= "_ ?' <br /> ----------------------- --------­------------------------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for alpermit to construct and install the work her'ein <br /> described. This application is made in compliance with.{County Ordinance,No. 5P and existing Rules and Regulations: <br /> -.JOB ADDRESS/LOCATION ./ is 'C� -: ' =` ''�Cr , . CENSUS TRACT <br /> r <br /> Owner's Name .. -------Phone ---- <br /> __ _ {��_ �-_ _ _ � -------------------------------- --- <br /> Address ------S.s ore-- --------------------•------------------------------------------------- CityV-------------------------------------------------•--•--.... <br /> Contractor's Name ------- / .` ----- y ---.License # ---- Phone + � ------- <br /> Installation will serve: Residence Apartment House❑ Commercial:❑Trailer Court ',❑ <br /> Motel ❑ Other ------ ------------------ ---_-------- <br /> Number of living units:.__,`----- Number of bedrooms ______Garbage Grinder���._ Lot Size .�d �- -.-------. <br /> Water Supply: Public System and name ________________ __-._--______Private, <br /> Character of so l to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom <br /> t Hardpan Adobe ❑ Fill Material ------------ If yes,type ____________________________ <br /> (Plot 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-orci&page'p - <br /> itpe�mitfed`if public,sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ]("'SEPTIC TAMC ize_ _ ____ _ _________ "`___ Liquid Depth__--__________,___. <br /> -a----------------- <br /> f_�^_ Type - _ Material ,4�i -_-_ No. Compartments ...._ <br /> D stance ,t�n�es� Yp� -- ` - ;=�ls� - -` � p �---------•---- <br /> r' t:._Welly . `+ ___- - -----------Foundation - Prop. Line,C le---- -------- <br /> LEACHING LINE No, of'Lines _ �------------- Length of each line_,0Z7_�____.______ Total Length __ -�________-. <br /> ' D rBo / Type Filter Material,�'L -D,epth Filter Material Ze ________________________________ <br /> Distand to nearest: Well _-�, _ ________ Foundation _ __`___________ Property-Line ./-,0z.r----------- <br /> ,y <br /> s� ,� <br /> SEEPAGE PIT Dei th Diameter �fi _ umber. --- Rock Filled Yes No <br /> p = . 1 <br />`R Ci- <br /> Ater Table Depth {'��---------- ----------------------- Rock Size p -. <br /> : Well ____,l' ____.- :___--Founda'tin__": �- Pro Line ���. .. <br /> Distance to nearest ... <br /> �_� <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ________ ___________________________________ Date _____--__ <br /> Septic Tank (Specify Requirements) ----------------------------------------------------------------------•----------- ------- 4----------------- <br /> f Disposal Field (Specify Requirements) ------------- -------------------------------------------- ' <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 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 - -Owne <br /> %:re, rTitle - -?7 - --- --------------------------BY ' - iI <br /> of er than owner) / <br /> FOR .DEPARTMENT USE ONLY 1 41 <br /> APPLICATION ACCEPTED BY =---------------------------------------------------------------------=--•-----. DATE ----7- P_6µ7;�r2— <br /> BUILDING PERMIT ISSUED -------------------------------------------------------- -------DATE -------------------------.----- -- <br /> ADDITIONAL COMMENTS ---------- ---------------- <br /> -------------------------------------------------------------------- --------------- -------------------------------------------•--------------------------------------- ------------------- <br /> -------------------------------- - - = ---------------------- ---------------------------------------------------- ---------------- <br /> ---- <br /> --------•----- <br /> ----- -- --- -- <br /> --- ---------- ----- - --- - <br /> Final Inspection by: ��--�-�-.----------- - ------ --------- -- ----------------------------------------------- <br /> --------- --Date �i�` ------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> A - <br /> ` E. H. 9 1-'68 Rev. 5M <br />