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r%JX %Jrrri,e UOes <br /> APPLICAroN r*R SANITATION PERMIT s 3 <br /> Permit No 7 <br /> . ...fCam <br /> (Complete In Triplicate) <br /> ...........a•............... ......... ... ... this Permit ixpires 1 Year From Date Issued Date Issued . ... ..7� <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 w€ County Ordinance No. 549 and existing Rules and Regulatlonss <br /> JOB ADDRESS/LOCATI N ...� �...�?....... .. ..P� CENSUS TRACT................... <br /> Owner's Name �G� '1�a....... .. ..� "Y# ... ..... ...Phone �.lf.:. fir. . <br /> Address ..................... e ....._.'City ..: •�"� ................ <br /> ...------ .: __ F - ..............License - 1.. 3... Phone . <br /> Contractor's Name .. <br /> .. .. . <br /> Installation will serves ResidencoIXApartment House Commercial OTraller Court 0 <br /> Motel 0 Other---•--•-- ----------------------------- <br /> Number of living units,....4-... .: 64 <br /> :. . Number of bedrooms ..-:Z_--Garbage Grinder ..._....... Rat Size .............X fJ <br /> 3.-_-•-_........... <br /> Water Supply: Public System and name .................................._....................._................4.................Private 0 <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay 0 Peat❑ Sandy Loom ❑ day Roam E3 <br /> '�•. R Hardpan[} Adobe Fill Materlal ............If yes,type............... .... <br /> [Plat plan, ahowln9 size a# lot, locatlon of system In relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATIONa <br /> (No septic tank or seepage pit permitted ;f public sewer is available within 200 feet,) <br /> ­ <br /> PACKAGE TREATMENT [ } SEPTIC TANK f )-- Size.............''....:.:.................. Liquid Depth . <br /> Capacity . Type .................... material--------- ............ No. Compartments ................... <br /> Distance to nearest: 'Weil ...Foundation <br /> • ........-•-•..................... ....................... Prop. Lyne ....................... <br /> REACHING LINE [ j No. of lines ........................ Length of each line........................_.-. Total Length ............................ <br /> V-Sox.T.�_Type Filter Material ....................Depth filter Material <br /> Distance to nearest: Well ........................ Foundation ..................`...... Property Line ........................ <br /> SEEPAGE PIT [ I Depth ..... .........:.... Diameter _._............. 'Number :5.� ...'�- ........... Rock Filled Yes ❑ No 0 <br /> Water Table Depth ................................`.............Reck Size ................................ <br /> 1 e <br /> Distance to en to -Well ........................................Foundation ..............:..... Prop. Litre ...................... <br /> REPAIR/ADDITION(Prov. Sanitation Permit di <br /> i .....................................-...... Data ...................................[ <br /> Septic Tank (Specify Requirementsl ................... ....... ..... ...............................�............._................ <br />' � <br /> Disposal Field (Specify Requirements) .-:.� c <br /> .....F .._...�. €.... ..................... ........................ <br /> k ------------...........•----••-.......---......- -•----• -- _.._.. ..._ ...... ....... ..�.. - - .._...........�.�} / fr`1 ��. <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 San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local. Health District. Home owner or Ifcen• <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 ...... ..................... Title r............................................... .... <br /> (!f ath th wner) <br /> 5_ ' DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY, 0/.... ...................................._.... DATE ... _. . ........... <br /> . <br /> BUILDING PERMIT ISSUED . <br /> ADDITIONAL. COMMENTS _ ....... --• -_-•----•__-.................................._...................................................................................... <br /> .. ..:............................ ...... ....... .a .,2� . <br /> .............._.••. ........... <br /> -.................... <br /> .................................................. <br /> . ... .. ... ._ .. _ _ <br /> ..... .............................. .... <br /> Final inspection by: ....... ................. <br /> 13 2!a "6� SAN�JOAQUIN LOCAL HEALTH DISTRICT 8/711 3M <br /> a <br />