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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 ��2 <br /> Permit No: ..................... <br /> :7 d (Complete in Triplicate) c� <br /> ..... ........... <br /> -�..�. <br /> . Date Issued ..l.��/•7.. . <br /> This Permit Expires 1'Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District fora permit to construct and Install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Ruies and Regulations: <br /> JOB ADDRESS/LOCATION ..... O.Q ....,. •F} / � u/,Tr.:y...." _... ....Y.CE ............ �......... <br /> . <br /> ,�,... _. CENSUS TRACT <br /> ./., ..... ..........P one <br /> Owner's Name ,......... <br /> I ............. city .............................Address _-.-.��. .�,�•.................. .i. -.........-..----........_................ tYmF ��� <br /> Contractor's Name ... _ � . -- /!l/..� ds � (icerlsa # � ,. Pone �� .. <br /> /,�< -. ...---•.sem �• fes! h .. <br /> Installation will serve: Residence Apartment House❑ Co mefdal'OTrciller Court 0 <br /> Motel ❑Other <br /> .Y..O... Lot Site ....... <br /> Number of living units:......... Number of bedrooms ...J. ...-Garbage Grinder ,/ vc -�••�•"�J�-•- -- <br /> Water Supply: Public System and name ---- ......................................--.............-..................... <br /> Character <br /> Pr va <br /> i to <br /> Character of soil to a depth of 3 feet: Sand❑. ..Silt❑ Clay ❑ < Pegt❑ Sandy Loom ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe; Fill Material If yes,type ............................ <br /> (plot plan, showing sire of lot. location of. system in relation to w6lls, buildings, etc, must be placed on reverse side..) <br /> NEW:INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 208 feet,} <br /> r <br /> PACKAGE TREATMENT ( ] SEPTIC�TANKA Size..�x. ...�' -eK...•G$F.....-- Liquid Depth ....5.................... <br /> Capacity f�40�L Type/ "�,_MaterialNo. Compartments ........... .O <br /> ........:...:Foundation p• <br /> Distance to nearest: Well ., �•-•• - _ ` - d••-----••--- Pro line ..��e .........::. d <br /> Length of each line...... <br /> Total Length ....,1. C �.-... <br /> No. of Lines ......-2..------•• h <br /> LEACHING LINE � .: <br /> 'D' Box Type Filter Material . G___C..,_Depth Filter'Material ../1 7......................... ..... <br /> ..Well <br /> r No <br /> ��}} Niembe� led Ye <br /> SEEPAGE PIT (� Depth .Gn-•�.. . Diameter „ ....._ . rrx�••••• f Rock Fil Cl <br /> 3 <br /> Water Table Depth...-�•0-a <br /> ....................Rock-Sixe_.. �...."(V.... <br /> Distance to nearest: Weil .........................Foundation _44?........... Prop. Line ..._,57-.......do <br /> A <br /> REPAIR/ADDITION(Prev. Sanitation Permit# Date .................................. <br /> } <br /> ....................... <br /> " "' ..... <br /> " <br /> Septic Tank (Specify Requirements) <br /> Disposal Field (Specify Requirements) ........................................................ <br /> ..................... <br /> I...... ........................... . _.�.. ..... :_ .... ...............................:........---• ----.........----.............................. <br /> -_. .. <br /> (Draw existing and required addition on reverse side) . <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 119*w <br /> ` sed agents signature certifies'the following: arson in such manner <br /> "i certify that in the performance of the work for which this permit is issued, 1 shall not employ any p } <br /> I as to become subject to Workman'w Compensation laws of California." " <br /> Signed .......................... ...- ........ ... "'}'"�................ Owner <br /> ....�..... ............... rifle . � 1:�'�/........._.......... <br /> B ... f. F� <br /> By' <br /> (if other than nerj ' <br /> FOR DEPARTMENT USE ONLY <br /> ............... DATE .... _ ......_ .............. <br /> APPLICATION ACCEPTED BY .... .. <br /> IC, - ........DATE ...--•..................................... <br /> BUILDING PERMIT ISSUED ............:�.------.:......-----......... <br /> .. .............................. <br /> ADDITIONAL COMMENTS ........................_.:......... <br /> .....:..............._.... <br /> ............. ..... -•--_..... ....................................................... .. <br /> ...----- ''........Date ........, __ <br /> . .... <br /> l - Final Inspection by: .....---- ............. ....... ..•- -- ....... .. .. .:.. - .. . <br /> s . - 9� <br /> SAN 10AQUIN- LOCAL HEALTH DISTRICT _r•, f �, <br /> 7/723 M <br />