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FOR OFFICE USE: <br /> yy APPLICATION FOR SANITATION PERMIT 7 // <br /> I 7 D (Complete in Triplicate) Permit No. ./ -. X? <br /> - -- This Permit Expires 1 Year From Date Issued 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 County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION 7 ,5� <br /> -OAr:,xo�J-d <br /> � <br /> _._ __-. . .._..- C._.E..N. SUoSneTRACT . .T. <br /> wner's Nome . . . -- --i-----.-.-.-.-.-.- <br /> .Address 14 <br /> A& . -. City <br /> r P- _ <br /> Contractor's Name License # .oZ sc} j cf j Phone <br /> Installation will serve: Residence ❑ Apartment Ho"�u��se�p❑�� Commercial ❑Trailer Court C1` Motel E]Other �r/LSV«f FpyydL <br /> ..............- <br /> Number of living units: /. Number of bedrooms . .v..-Garbage Grinder . Lot Size <br /> Water Supply: Public System and name __ .............Private <br /> Character of soil to a depth of 3 feet: . 5and❑ Silt ❑ Clay ❑ Peat❑ Sandy Loam ❑ 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,) <br /> S <br /> PACKAGE TREATMENT ( ] SEPTIC TANK Size __ . S�.X..�. _ Liquid Depth . 5 - -----------G, <br /> �s <br /> Capacity 1>-(-V? Type P40147._ - Material.0 nG c. No. Compartments - ............%P <br /> Distance to nearest: Well r S <br /> Foundation /Q... . Prop. Line ... _._............ <br /> LEACHING LINE No. of Lines Length of each line /dD Total Length _/ ................_V% <br /> 'D' Box Type Filter Material —614, _..Depth Filter Material .. le_.". ....................- <br /> r <br /> Distance to nearest: Well ...SO.-"t Foundation /O_--F-. _ property Line .�-.r.�.......:..- <br /> r , <br /> SEEPAGE PIT Depth ZS Diameter . ....._. Number �...... _ Rotk Filled Yes ff No Q <br /> Water Table Depth . ___ _ ___................-----.-..Rock Size <br /> rr <br /> Distance to nearest: Well ...../0Q.... ...................Foundation _�f°/-- l .. Prop. Line ... .._ ".... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# __ . . .- . . .... Date ... . <br /> Septic Tank (Specify Requirements) _ ._. _.. _.._. ) _ . .......�J <br /> Disposal Field (Specify Requirements) ._...._._......._........... . <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 /> "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 i l.(J__.. f.--- (. X� _ . Title � _ . . .. <br /> (If h r than owner) <br /> PARTMENT USE ONLY <br />.. APPLICATION ACCEPTED BY DATE —j/�--7�. <br /> BUILDING PERMIT ISSUED _ _ DATE _ _ _ _ _. ..._. <br /> ADDITIONAL COMMENT$ . <br /> Final Inspection by _ Date . <br /> - ----. . ._... - <br /> N J QUIN LOCAL HEALTH DISTRICT <br />