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FOR OFFICE USE: - <br /> APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: <br /> (Complete in Triplicate) Permit No.7.F— ( .- <br /> This Permit Ex ires 1 Year From Date Issued Date IssuedlL:. . <br /> ...... .......... p <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations; <br /> JOB ADDRESS/LOCATION..?�47—?) 7,..- � M 7"v y�7, E C <br /> Owner's Nome_ /-14-^!...... 5 <br /> �/7..�4 .• IZ_� <br /> CENSUS TRACT----- <br /> `/ .................... -- '/ <br /> Address..._.... .S.t _ .. .. Phone - --- -�------�_..._.. <br /> ,--• ... ----.............. _.. Cit 6 [� <br /> City...................f!...�.T....h�---- - zip---- --- ------- <br /> F <br /> ... <br /> Contractor':; Name_.t .Q-c 1� .� .c�?- . <br /> _........... ......License #...------- Phone..�`.4+_ '.5 .. <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial [] Trailer Court <br /> Motel ED _Other-------------- .. <br /> Number of living units:.....b2.....Number of bedrooms......... Garbage Grinder..----------Lot Size._---0?1. .Q (" ►^fS <br /> Water Suppfy: Public System and name.. .........S,._-q-I_..�i(/�r <br /> ..... ....._.._.,...... . . ........Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt Clay ElPeat ❑ Sandy Loam El Clay Loam ❑ <br /> 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 or seepage pit permitted if public sewer is available within 200 feet,) G) <br /> PACKAGE TREATMENT [ ) SEPTIC TANK <br /> [ ) Size..._.......... ... ------Liquid Depth--------................... <br /> Q. <br /> Capacity--- - ----------TYPe--- ------------ -----Material...... --------• <br /> ..._.__._No. Compartments................... <br /> Distance to nearest: Well---------------------- - - - ----_-. ----Foundation.......... ..--.-.----- Prop. Line---.-- ................ � <br /> LEACHING LINE [ ) No, of <br /> Lines - of each line . ' <br /> _ .... ----...... _.. ................. -----....._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. <br /> SE---- ----------1--------------_- / Rock Filled Yes ❑ No i Water Table Depth .QQ.-------...- .Rock Size-------ITCr.��.G..l"oe'� <br /> Wc. <br /> Mitance to nearest: Well--------- P. ...........Foundation....._... ..............Prop. Line................. - . <br /> REPAIR/ADDkTION (Prev. Sanitation Permit#........_7�f"id�' .........Prop. <br /> ........ ..........) <br /> _...._.. _ .. <br /> Septic.Tank (Specify Requirements).._.. ...___._ <br /> ............ ... ................__------- ---. ._ . <br /> .......... ................ <br /> ._. <br /> Disposal Field (Specify Requirements)........I............. <br /> ----------------- --- - ---------- ---------- •-------- . ---- ------ ... ................... ....---- ---- ---- <br /> -----•--- ----- - --- ------ •--- ----....._....._-----•-------- - __ ........ ..--------------------- <br /> *....... <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 Son Joaquin County <br /> Ordinances, !hate Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> 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 as <br /> to become subject to Work n'a Compensation ows of California." <br /> Signed.,...��5�!�-�,c, -- <br /> -"' .Owner <br /> By-•---------------------------................... ....... <br /> ------ --------Title. - ........ .................. <br /> (If other than owner) <br /> FO DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-----•.---. - /j'�'^^ ...._lQ DATE ---_.. ...... .-. - <br /> DIVISION OF LAND NUMBER............... DATE..-- <br /> ...- -------- ---- --- ----- <br /> ADDITIONAL COMMENTS... - <br /> .. 0 <br /> - -------------- - --------------­­ . ---- -- -- ---- -......... ............. <br /> ------------------ <br /> Final Inspection by;....... . A <br /> ....... .....� . - ------•------------ ---•--------...._.--- -_------------- -- ----- ---Date .../ .._3� <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M <br />