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FC OFFICE USE: APPLICATION FOR SANITATION PERMIT _ <br /> ..................•---...... Permit No. 7 :_ 5.7. <br /> ........................................... <br /> (Complete in Triplicate) <br /> r' ' Data lssued '.7-,w <br />........................ ......... • This Permit Expires 1 Year From 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 /> .SOB ADDRESS/LOCATION...,7_.f9._�49_:./ �,0/-S..........:..................................................CENSUS TRA <br /> . <br /> Owner's Namentt <br /> Q� ... 11 �� ��7 ........... ,._... :............. Phone 4p <br /> Address _.... ��� ........... City . r ..................... .... ..... • <br /> .. _..... <br /> Contractor's Name ...... . 7 4��-. _. .��✓.. ...........................................license #,� �". !91. Phone . <br /> Installation will serve: ' Residence AportmenUHouse f] Commercial ❑Trailer Court 0 <br /> f <br /> Motel C]Other <br /> ........................ <br /> Number of living units:...,l_._...'Number of,bedrooms .._...Garbage Grinder , ---- Lot Size ..................: <br /> Water Supply: Public System and name':...........r...: ...............Private,jff <br /> 4 �V <br /> Character of soil to a depth of 3 feet: Sand t r&lt❑ Clay ❑ _ Peat. Sandy loam fl " .Clay Loam F <br /> ,-�w Hardpan ❑ Adobe Fill Mnterial ........ If yes,type •--.......:..`............. <br /> (Plot pian, showing size ofAot, location ofsystem-in relation to wells, buildings, etc. must be°placed on reverse side.) O I <br /> NEW INSTALLATION: (No septic topk or seepage pit permitted If public sewer is available within,200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size_.....--:._..._._.•................ Liquid Depth __....._......_. ......... <br /> Capacity ... Tye Material...................... No. Compartments ................. <br /> —...Distance-to-:nearest:Weiler.. .............................. Foundation .............-_-.....:Prop..line ................. <br /> ;:- <br /> LEACHING LINE [ j No. of Lines ........................ Length of each line............. Total Length ..................I......... <br /> ial Depth Filter Material <br /> Distance to nearest. Welles Mater <br /> A <br /> YP <br /> .......... foundation .'....................... Property Line ........... I <br /> SEEPAGE PIT [ ] Depth Number Rack Filled Yes Q No Q <br /> ----------------- Diameter .........._..._ -. <br /> Water_Table,Depth Rock Size ...........................:::.. <br /> Distance to nearest: Well ........................................Foundation ................. Prop. Line .............:........ <br /> REPAIR/ADDITION(Prev. Sanitation Permit,# . ...- Date . ..:..: <br /> Septic Tank (Specify Requirements) .._ .. ........ ... <br /> Disposal Field (Specify Requirements) # <br /> ................................. ............................. <br /> ........................................ <br /> ----------------------------------.-............................................ <br /> (Draw existingand required addition on reverse'std <br /> 1 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,,) 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 ..................... <br /> _..r..-•-•-•—........................... Title . r Gi d . ..._.......................... <br /> (If er than owner <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ... -----------------...........................7...................... DATE ...... . ...f.._ . .......... <br /> BUILDINGPERMIT ISSUED -----... ........ ----•---•-•......................... ......: ................... ..............DATE -_................................... <br /> ...... <br /> ADDITIONAL COMMENTS .............................................................................. <br /> ...._.__........ <br /> ............. ----------•....................................... -----•-.............................................. . <br /> -------------------------------------------- = ..................... <br /> --......................_........_.. <br /> . <br /> Final Inspection by: ...:....... ....Date / <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT � <br /> E. H. 1.3 241-'68 Rev. 5M 7/72 3-M <br />