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OFFICE, USE: ` FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> 7 <br /> ------------------------------ ---- ------------------- Permit No,- <br /> Tplite 164-ripli <br />- ---------------------------------------------------- --- <br /> /-g/- 7,7 <br /> ------------------------------ -------------I------- This Permit Expires I Year From Date Issued Date Issued-'-3--. <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work-herein described, 1Q, <br /> This application is made in compliance with ty Ordinance No. 549 and existing Rules and Regulations: <br /> -CE US TRACT.--........ ---------- ---- <br /> NS <br /> JOB ADDRESS/'LOCA 0 - --- --- -- -- -------------------7 ------- -------------------- <br /> Owner's Namef- <br /> ------------ 7----- - -- ---------- ---- Phone------- ---------- -------- <br /> Address---/-Z/I ------------------------- ---- City.- --'---'--Zip---------- ---------------%---. <br /> Contractor's' N ------------ e�n -3 ------ <br /> Name.---- - ------- ------ ------------------------- Lic se #�02 2 IS _'7 Phone--- <br /> Installation-will serve: -f_ Residencey.: Aparim6nt House E] Commercial'E Trailer Court, j <br /> Motel ❑ Other- ---------------- --------- -------------- <br /> X <br /> Nu I mber of livin ------Numbercf be'clro� G b Grind e--- <br /> 9 units 6ms or age er, ot Siz -- - ------------------- <br /> Water Su Vublic Syste )-------------------- -----------------------Private <br /> pply: rn 6nd narrie---------------- --- ---- ------------ - -- ------- <br /> Lo6m 0 <br /> Character of soil to a depth dK3 felet: Sr. and S.i It Clay 0 Peat, Sand Lo "m' :Clay <br /> y s, <br /> Hardpan E] Adobe jKj FIflkMateria e type --- ------ -------------- <br /> (Plot plan, shoMng size of lot, Iocatidn of system in relation)towells, buildings, etc,'must l e placed on reverse side.) <br /> NEW INSTALLATION: '(No _septic tank or seepage pit permitted'if public sewerls. available within 200 feet,) <br /> PACKAGE TRE4TMENT. . .-SEPTIC TANK [1 Size--- -- ------------------- ----------- i uid Depth,,- ----------------- ---- <br /> N Capacity_�_-_j-------------Type....:_.-----z. . ---- -Material -------r-----i-: ---t''-Nlo' Compairtments_--- ------------ -------------- <br /> ---------- <br /> Distdnce.to nearest: Well-------------------- - ------- --------- Foundation-------I------------ -----Prop. Line-------- <br /> ------------- -------------Length of each line -------------- <br /> LEACHING LINE:j.. 11 No. of Lilnes- J_Toto)' Length --------------------------------------- <br /> `D' Box- .!--Type Filter Material:-------- - Depth Filter Material--:---------------------------- <br /> -----------:---------- <br /> Dista�!ncek nearest: Wel!_' .Foundation- - ------- -----------Property Line------------------------------------ <br /> ------------- <br /> SEEPAGE PIT Depth---.,- ---------Diameter ...... ---- Ro& Filled Yes ❑ No <br /> Number-- ----------------- ---------- <br /> f. <br /> 7 14 <br /> Water <br /> ter Ta61eDepth-------------------------------`-------------------� ; --F6undation---- Rock Size.---;---------------------- ----------------- <br /> " <br /> DSan <br /> We - ---------------------- - - - ------- 'Prop. Line--------------- ---------REPAIR/ADDITION (Previtation Permit#-i--- ---- --- --- ------- -------------------------------- <br /> a -- ---------- - - <br /> tV_ <br /> Septic Tank (Specify Requiremencs)',__----- ---=-- ---------------------------- <br /> --- - - ----- ------ .......... <br /> e5l <br /> Disposal Field (Specify Req )m6hts) ---------------------------------------------- ----------- --------- .... <br /> Requirements) e ------ <br /> ------------------------- ------------------------ ------------------------ <br /> ---- ---- ----------------- ----------------- <br /> qk <br /> -- ---- ---- <br /> --- --- - ----- ---------------------------- --------------------- --------------------------------- ------ --------- ----------------------------- - <br /> _21 (Draw existing ng �1_ <br /> and-'k r6quircicl-pdditi n"on reverse side) <br /> I hereby-certify 1jthat,l haveiki prepared tthis application and that the work will be done in accordance with San Joaquin County' <br /> Ordinances, State Laws, and Rules rand Regulations of the Son Joaquin Local Health District'. Home owner or licensed agents\., <br /> signature certifies the following: <br /> N certify that-in the p!ff.ornance.of the work for which this permit is issued;-1-shall nct employ any personi in such_ manner as <br /> an' Cc. <br /> to becom" 'gtto,R49 man' Ompensation-laws-of—Calif.or.kia." <br /> ? <br /> p <br /> -' ---- <br /> it <br /> --- ---- ---- -- -------- ------- ------ ---------------- ----Owner <br /> ----- --- ------- - --------------------------- <br /> 'y `_7 <br /> B j1 �.-- - --------------------------------- ---.Title. <br /> ---------- <br /> - <br /> (If other thwn caner) <br /> _4 <br /> —FOR <br /> -DEPARTMENT-USE <br /> -ONLY <br /> APPLICATION ACCEPTED BY------- ---------------------------------------------- - ---DATE-.,-,----- �/_2.7-------- <br /> --- ------ ---------- <br /> DIVISION OF LAND NUMBER_ ----DATE--------------- --------------- ---------------- <br /> ----------------------- --------- --------------------- <br /> --------------- ---------------------------------------------------------------------- <br /> ADDITIONAL COMMENTS ---- ------- <br /> ----------- ----- _`-------- ---- - --------------------------------- --------------------------------------------- --- ------------------------------------- <br /> -------- - ----------------------------------------- <br /> -- ------------- - <br /> ----------- <br /> --------------- <br /> ---- <br /> -------------------- <br /> ----------------------------------------- ---------- --------------------------------------=--`=-."'-- <br /> -­ ------- --------------------I-------------------- ----------------- <br /> Final Inspection by:-- Z-------------------------------------------- --------------- ----------------------'Date <br /> -77 REV. (/f63M <br /> EH 13 24 2111 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />