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y <br /> APPLICATION FOR SANITATION PERMIT S-7 <br /> Permit N6. ......:.:.....:. <br /> (Complete,in Triplicate! <br /> This Permit Expires 1 Year From Date Issued <br /> Date Issued <br /> i,creby made to the San Joaquin Locoi Health District for a permit to construct c;nd install the work herein <br /> `his application is mode in compliance with County Ordinance No. 549 and existing Rules and Regulations( <br /> 'C")�E�S/LOCATION . �.�. .-.... ....`.�"'..1..od-a T^.......................CENSUS .w <br /> «. QQ TRACT <br /> s Name .. .. 1..'t �........... .. <br /> .... <br /> .. <br /> ..................[its r..�. <br /> '.'Lcrar'a Nome .... ...�. c.I`!::... ..License ..Phone• •�,�,�lP <br /> �.3- tion will serve:, ResidenceApartment House[] Commercial[]Trailer Court Q ' �_ . � #°',4 <br /> xl[o]Other.........:.....{........: .. �:....�_, <br /> ^+i : <br /> of living units:.. ....- Number of bedrooms .-- ----Garbage Grinder�` pp........ Lot S(ze ....7¢...aSl,i 4........ ... xc�a <br /> -+ Supply: Public System and name .............. 1/fhri � ❑ t` <br /> 1 fi <br /> .................................. ...... . _ ......._..............................Private <br /> —roct.er of soil to a depth of 3 feet: Sand r] Silt j] Clay ❑} Peat[3 Sandy Loam C3 Clay learn❑ <br /> Hardpan 0 Adobe Fill Mflterial ............If yes,type f ' ... ' .. <br /> _ ^Ian, showing size of lot, location of system in relation to wells, buildings, etc. must ba placed ori rive n s4119.1 <br /> '17W INSTALLATION. (No septic tank or seepage pit permitted If publlc sewer is available within 200 fQtfJ_' <br /> ",kCKAGETf� EATMENT SEPTIC TANK Size................................................ Liquid Depth .............. ` <br /> Capacity .................... Type .................... Material...................... No. Compartmems .... ' ......t. F .. , <br /> Distance tomnearest, Well ....................................Foundation...................... Prop.Lime......... •+ <br /> LEACHING LINE [ j No. of Lines ................... .... Length of each llne,......................_... Total Length ................ �...��:.� <br /> 'D' Box ............ Type Filter Material ........ ..........Depth Fiher Materials ............... ...:." .....:...;«..p <br /> Distance to nearest, Well ........................ Foundation ........................ Properly-fine ................... •r <br /> SEEPAGE PIT [ } Depth ......... m <br /> ........... Diameter Number .. <br /> er ................ ..........................Rock Filled Yes ❑ No» , <br /> Water Table_Depth ..........................................._'.Retic Size............. .................. <br /> Distance to nearesh Well ................................. .Fo mdatlon .................... Prop. Litre ........._... ` <br /> REPAIR/Ar,DITION(Prov. Sanitation Permit .......................................... Date .................................ii <br /> OC <br /> Septic panic (Specify Requirements)'................... ' 1, .... ........................-. ...»........_.`...... . <br /> i:ispcsal field (Specify Requirements) ...(.--(x GC. ....i[i._ .f. �..R. <br /> ..... <br /> .rinCR.:?............ l <br /> ......................... .................................................................. : .............I.. ................................ l <br /> ......: ...............I........................... ................... <br /> (Draw existing,and.requlred addition on revere side) y <br /> I hereby certify that I have prepared this application eked that the week will be done In aceordenp with San Joaquin <br /> County Ordinances, State Laws, and Rules and RegwItWons of the fan Jeagvin lltaeal He" District.(lepra awner 11cew <br /> sed agents signature certifies the followings All <br />"I certify that in the performance of the work for which this pomslt Is hsved.i shall net ernplet►arsy person In weir manner <br /> r.s to become subject to Werki»an's Cotrtpatsatiart laws o►California" <br /> Signed ... Owrw <br /> �. .. .. <br /> r., r Title <br /> ;If of� �� tear owner) . <br /> DMM= USE ONLY j ;' <br /> A�IUCATION ACCEPTED BY.... ..i..... DATE....�-. .`,.�.� <br /> .... <br /> 'L3 i I.`JC PERMIT ISSUED ...........- // <br /> .d <br /> DATE .....................r................... <br /> Of:AL COMMENT; <br /> .-......`s"' .".'.."f�fT� .......•.......... ........................................................I.............I... .. a <br /> by: (� ... .-Ci`: .. ........ ..................................Date. .�i ... t�[).................. r <br /> SAN JOAQUIN LOCAL H .......ALTH DISTRICT � <br /> ,s fi 5AA 7172 3 M 11 <br />