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FOR OFFICES' FOR OFFICE USE: , <br /> APPLICATION FOR SANITATION PERMIT <br /> -_.--. Permit No e <br /> , (Complete in Triplicate) <br /> r <br /> .� 1 Date Issued_V f3�- � <br /> ............ ............... <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 described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: rt <br /> J. -' ... CENSUS TRACT................ <br /> JOB ADDRESS/LOCATIO ::- 1 . . ._. . .. <br /> _' ppi Phone.... <br /> Owner's Nome ---------- :...rrw`...... .. .m ... <br /> '-- <br /> Address_._.......... ` + <br /> .�s .. C.tV,r(,.C/�'fZ ! .......City-- --- ZiP <br /> Contractor's Name.&, Ju t.?. ,It_,�_...A.,&,. std-.,JAW—kicensePhone. <br /> ' �-- <br /> -- --- �-- ---� <br /> Installation will serve: Residence'° Apartment House ❑ Commercial ❑ Trailer Court ❑ i <br /> Motel ❑ Other........................ -------=-------------- <br /> Number of living units:...../-------Number of edrooms...J....Garbage Grinder._ 45 .__Lot Size____U.-.�..x -/ ---- ---- ------- <br /> Water Supply: Public System and name..... -4s'0 4C-' ' . .....I------- -------- ------------ ---------- ------- ----- ,-••--'-- Private <br /> 0 <br /> Character of soil to a depth bf 3ffeet: :,Sand E�- =Silt❑ -Clay-{�: -'Peat ❑ -. Sandy Loam ❑ :} .Clay Loarxi.(]..',, _.;,-a,:_, _ .,�, ' , <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 /> PACKAGE TREATMENT [ ] SEPTIC TANK.X ' Siz r ----- ` ---. Liquid-.Dth-------- ... . ......_ <br /> P mac u�F'C� <br /> Ca acrt T e- pterial ._--- ---- - No. C mpar rrients <br /> .,r .. �.� <br /> �. <br /> Distance to nearest: Well_. 2P►- o.�C �hag fou tal�Eengthrop -_....- <br /> qq v rf <br /> LEACHING LINE [ ' No. of?Lines -- pC..... 9 a ` <br /> 'D' Box_../.....Type Filter Material../� .......Depth Filter Material__ :_h_ _ ............. <br /> t E•'Pro ert Li ..._ <br /> Dist6nce,to nearest: Well-_ '_(R' ! -.Foundation... :.,;-��-_z.:. p Y...ne. } <br /> r s <br /> SEEPAGE PIT [�(f Deptli..ib[ ....Diameter---- ........Number- --_ , Rock Filled Yes' No': <br /> Water Table Depth <br /> °rDistanDe th......__�r ...-. '..:-- ....---------Rock Size---- -------• <br /> ce to nearest: Well--- atin._.f. ProP• Line ' <br /> - f- ...._... <br /> __.�Foundo .. .. . <br /> REPAIR/ADDITION {Prey.:;Sanitation Permit#--------------- --------------- '••_.. -------- ------'----] <br /> --------------------- <br /> _ . ...... <br /> x .................. <br /> -Septic Tank 15 ecifY'Re uirements►. .... ........... .. . . ... = <br /> , ,tDisposal Field (SpecifyRequirements]-- -._....-. -` -------- "' .:•.:�... -- ---=- • - ---------- ------ <br /> --------------------------------------------- _...-------_----- ..------ _•_•_,_•------- _ _.._..._--I......_.-- ..............._-...---------------_---.................- , <br /> s ----- ------------ ---•---- <br /> ...."........ - ------------ -` -----... ...... . --------:..... ..----•' --- ----------..._._---•------------r--------- - --- -r <br /> I (Draw existing and required addition on reverse side) Ll <br /> I hereby certify that I have prepared this application and that the work will be done. in accordance with`San Joaquin County,. <br /> Ordinances, State taws, ands Rules,and Regulations of the San Joaquin Local Hedith District. Home owner-or licensed agents., <br /> signature certifies the following: a -4. s <br /> "I certify that in the performance of-the work for which this permit is issued, I shaft not employ any person in such'-manner as <br /> to become subject to Workman s Compensation-:laws of California." C �PIiEE E'S SLPIIC & S�_VVFR S� <br /> LRvIGE <br /> Signed-_. ` -- - -- .--..----Owner 263 So. Cro Sto..kton, Calif. n52t35 <br /> �. <br /> BY ...:_..w _.. I l L R-. . ..._4� <br /> T'tle h 4.u':3�v Cankr^ SLi_c_ G6 <br /> (If othf'rZ76wnee) <br /> R PARTM N SE LY ? 4 <br /> i r? .._.. .DATEi--- ---- .. 3 <br /> APPLICATION ACCEPTED BY_...._..._. . r <br /> ------ ---------- ------------ ----- ------------....---- <br /> DIVISION OF LAND NUMBER.....--- -------- - - -------------DATE- ....--- ... ........ <br /> ADDITIONAL COMMENTS .. <br /> ------- .............................. -------------------------------------------- <br /> -. <br /> -------------------- ----.--.- .-- <br /> F ............. ._ _.._ <br /> Final Inspection by '-......... . ...................... <br /> t Eli 13 24 �~ w'`"� "� "SAIV'JOAQUIN kOCAI�H�ALTFi DISTRICT :s ' "F � °-��^^-J, 1677REV, 7176 3m <br />