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USE: . <br /> APPLICATION FOR SANITATION PERMIT Permit No. -7 <br /> S,.. <br /> (Coifoete`in-Trlpltca#e) . __..._ _, <br /> .............. <br /> w - - `_.Date Issued . ...y........:.... <br /> .w - .- <br /> ""' This Permit Expires 1 Year From Date Issued <br /> ....................................... .. ...... <br /> itru <br /> and <br /> rein <br /> rmit to com <br /> Application is hereby made to the San Joaquin LocwYHl. Cou CDistrict inarnce No. 549 and existing g Rulestand hRegula}Ons' <br /> PP in compliance <br /> described. This application ism e p CENSUS TRA i <br /> JOB ADDRESS/LOCATION ... — <br /> . ...� ...Phone .. .� ....... ... ... <br /> .. <br /> Owner's Nonpe <br /> Address �� /` 'c�:r.. �. ........ ........... Ci ....... Phone .............................. <br /> Contractor's Name ......................... ........•------•----••--.._...:......_............._.....---• <br /> :.License .. ' <br /> Commercial[]Trailer Court 0 <br /> installation will serve: Residence©Apartment Housefl <br /> Motel Q Other .... �iL • .. .:�/.��......... . ........... <br /> ..... <br /> fj Lot Size � !...... .... 1 <br /> Number of bedrooms _.__..___... <br /> Garbage Grinder� --"••"""-""'•" !' <br /> Number of living units:...• ...---- Private <br /> Water Supply: Public System and name_---------------•---•--.. ...........................................................:.......................... <br /> Ga Peat❑ Sandy Loam E] Clay Loam Q <br /> Character of soil to a depth of 3 feet: Sand'[ Silt Q filo iiteeat Y type <br /> "" <br /> Hardpan Q Adobe ............ If es, a ............. <br /> size of lot, Eocation of system in relation to wells, buildings, etc, must b.9,placed on rover <br /> (Piot plan, showing se�:'.side.y, <br /> Y permitted if public sewer is av�;ilable within 204 feet, o <br /> NEW:INSTALLATION: (No septic tank or seepage pit p ,pl ►t �.................. <br /> TREATMENT SEPTIC TANKeT <br /> Size__�""�f._�-.6-4 A.........:_ Liquid Depth. fe <br /> ,- .. <br /> PACKAGE L ] ;— <br /> CDuCerl._. No. Compartments . Y <br /> �� eAli . Material-----•-••-••. -.Capacity - --- --- p r . Prop.�Line .�............... 0 <br /> � Foundation _. � .._.�........ <br /> _ Distance to nearest: Well --•-• -----••-------'•-••' - � ' <br /> ; .--•-- .... Length of each line..-.,f�.-- -0..._..._. Total Length •-�&A............... . <br /> TEACHING LINE I ] No. of Lines -. -- �1`" <br /> (/ <br /> epth Filter Material ..o .c1.._._.... <br /> 'D' Bax I� Ir/&Type Filter M teri •, <br /> al _ f` <br /> e <br /> t <br /> ..r ...._ Property Line <br /> Distance to nearest; Well .._..._. .... -'- foundation <br /> 'Rock Filled Yes ❑ ' D <br /> Diameter _..:...._ Number _...-------- <br /> No <br /> SEEPAGE-PIT," L 1 Depth _.._...------ <br /> '. Water Table Depth -----••---- k Size ` <br /> Foundation --......__.'.._.. p <br /> g Distance to <br /> nearest: Well --•------••-------•..:..........•-----• � Pro Line ......................i <br /> - --�-----•�-------- Rate .................:............••-•1REPAIR/ADDITION(Prev. Sanitation Permit�# .•--_- ---- - ............ <br /> .................. ------------------- <br /> --------------------- <br /> Septic <br /> - <br /> Septic Tank (Specify Requirements) ------­----------------- <br /> ------------------------------------------ <br /> Disposal <br /> - <br /> Disposal Field (Specify Requirements ------ -------------- F- <br /> II...___--_----------------------- - -- ----------••----_------ --- <br /> --------- • - .. - - t _..-----... .............. <br /> y* II <br /> •---••------•-------•------ ---- ---------- <br /> ( ----'---------'- . °- - (Draw existing and required addition on reverse side <br /> certify that I have pr ed,.this application and that the work-will be done in accordance with San Joaquin <br /> I hereby <br /> I nd Regulations of the San Joaquin Local <br /> County Ordinances, State Laws,:and Rules aHealth'Distrlct.•Home owner or lRen- <br /> k sed agents signature certifies the following: : ermit is issued, I shall not employ any person in such manner <br /> ( "I certify that in the perforrna f the work or which this p <br /> as to beco Wbje t or 's pen ion laws of California.,' <br /> t Owner i <br /> Signed --------- - -- - p,.* . <br /> a <br /> . jitl + <br /> h (If other than owner) . <br /> f FOR ARTMENT USE ONLY r <br /> f C ;DATE .. - rrj <br /> APPLICATION ACCEPTED BY : .::: _ .- i :.:: ------- - -A` - " 'DATE' :.._......._. <br /> BUILDING PERMIT ISSUED . .. r <br /> •- -- . <br /> ADDITIONAL COMMENT . - ---------------------------•------------------- ._._........... <br /> I --------- -- ------------- ---. •------.------- - ---------.-- _:._...........---------- •---•---•------- ------•._.........-- <br /> ._. <br /> .....--- _ <br /> r _______ _ ___________ __ Date .r�••' .--- <br /> ._..... <br /> Final Inspection lsy- ------ ---- --- 8/71� 3M <br /> Elf 13 24 1-68 v. �M �' SAN JOA IN LOCAL HEALTH DISTRICT <br />