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f <br /> FOR OFFICE USE: <br /> APPLICATION FORSANITATION PERMIT 7c,/- 7.. <br /> - Permit No. . .............— <br /> . . <br /> (Complete <br /> in Triplicalel <br /> a: _ i.... . . Date issued . . .. ......... <br /> This Permit Expires I Year 1 rom Date Issued <br /> ~ Application is hereby made to the Sun Joaquin Local Health District for a permit to construct and install the work herein <br /> described..This application is mode in ccmplionce with County Ordinance No. '•40 and existing Rulrs and Regulatltutss <br /> � <br /> CENSUS TRACT .......................... <br /> JOB ADDRESS/LOCATION ......Phone <br /> ' Owner's Name ..... City '0�A <br /> 7''f.f.i ............................. <br /> Address ✓`�fv]E <br /> r tR v1��S ,�Phone p73P 11��r.. <br /> Contractar's Name Z�L"/'L Lir.ensp. <br /> Install6tion will serve: Residence[J Apartment House❑ Comm%,rciot ❑Trailer Court ❑ F <br /> Motel ❑Other _ <br /> 1 Lot Size . .. ............ ................. <br /> Number of living units: / Private)v <br /> Number of.bedrooms ._3.....Garbage Grinder <br /> .. .--..... . <br /> Water Supply: Public System and name Peat❑ Sandy loam R Clay Loom❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay E3 <br /> Hardpan❑ Adobe ❑ Fill Mfateriol if yes,type <br /> be laced on rfMrse <br /> pp 1Plot pion, showing.size of lot, location of system in relation to wells, buildings, etc. must p <br /> k (No septic tank or seepage pit rermitted if public sewer is uvatlabie within 200 feet,) <br /> 1 liquid <br /> NEW INSTALLATION: Depth .. .. ............ � <br /> .: SEPTIC TANK{ ] Size.... _.-....... .- <br /> PACKAGE TREATMENT { ] No. Compartments. . ..••••••.••••••J <br /> Capacity Type <br /> Material "" <br /> ,. �< a ........... <br /> Distance to nearest: Well <br /> ..... .Foundation . Prop.lin .....-. <br /> i H <br /> Total <br /> Length <br /> Length of each line <br /> LEACHING LINE No. of Lines <br /> _ Material -... . ..... <br /> . ..................... . <br /> D' Box 7YPe Filter Materia . ....... ... <br /> Line <br /> Distance to nearest; Well .. <br /> Foundation Property <br /> tDepth Diameter Numbe <br /> Rock Filled Yes ❑ No <br /> SEEPAGE?IT ( .1 .......Rock Size ... . . . <br /> Water Table t:epth <br /> prop. line ................... <br /> Foundation <br /> P <br /> Distance to reorest: Well <br /> yi4 <br /> . Date ..:..................-....--......I <br /> REPAIR/ADDITION(Prev. 5anitatior. Permit# ..-..... -It <br /> , ........ .... <br /> .. <br /> Septic Tank (Specify Requirem ntsl <br /> • � �. •- <br /> f Disposal Field (Specify Require ents) .- - . . . .....I....... <br /> .. <br /> .. <br /> (Draw existing and required addition on reverse side) <br /> :- prepared this application and that the work will b+ done In accord <br /> 1 hereby certify that have once with San Joaquin <br /> ' County Ordinaries, ;tale laws, and Rules ansa;Regulations of the Son Joaquin Local Health District.Horn* owner nr liter• <br /> sed agents signature certifies the following: <br /> "I certify that inthe performance of the work for which an <br /> this permit is issued, 1 shall not employ y person in such manna <br /> jas to become su%eject Wer n's Co ensalion laws of California. <br /> Signed <br /> I.-... -.. ... .. Owner <br /> IE Title <br /> By <br /> pfother than.owner) <br /> MENT .USE <br /> FOR DEPART ONLY <br /> .- <br /> .. ., DATE . 7 Y . ... <br /> 'APPLICATION ACCEPTED BY ✓l' DATE <br /> BUILDING PERMIT ISSUED. <br /> ADDITIONAL COMMENTS . . . ..-_ . ._ <br /> . . 7 _ ....... .pate . )! .......... ... <br /> Final Inspection by!%.— <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 7/723 ,4 <br /> E.H.." z41•'6'8 Rev. 5M <br />