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FOR OFFICE USE; FOR OFFICE USE: <br /> ^� �• "'' APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) <br /> Permit Na.. _. ---.1�... <br /> Date Issued.'. . <br /> a <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. 1 <br /> This application is-made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION --------------------------------CENSUS TRACT------------:.-..-------........ <br /> Owner's Name.... ...... ' O on <br /> R...Gl1 ---•.... h e C/. Tlr:?�Oq i <br /> Address -- 38_� . G. C1.-- .t✓G�9Y7-. 7a - / ....-, S ....City------- --TOCK ------ 3Contractor�sName. ----- - ---- --- ----License 3� Zi <br /> P- <br /> V46'�460✓ <br /> . ­ <br /> Installation <br /> I <br /> jwill serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ j <br /> Motel ❑ Other-...... <br /> Number of living units:....-.f.......Number of bedrooms....z .. Garbage Grinder............Lot Size.--.----...6.4 ZOO . <br /> Water Supply: Public System and name..... <br /> ....-CIT . --- - --..Private El i <br /> Character of soil to a depth of 3 feet: Sand E:) SiItyD Clay ElPeat ❑ Sandy Loam E] Clay Loam ❑ <br /> Hardpan E] Adobe g . Fill Material.. .-- -.-.If yes, type....-----------------------L... <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 avflilable within 200 feet,) <br /> PACKAGE TREATMENT [ ) SEPTIC TANK [ ] Size ............. .------------- ------------------------------Liquid Depth.------._-.-------...--.--- <br /> EXlSTlN <br /> � Capacity.....-- ------------Type------------.... - -.Material..---------------•- -----.No. Compartments.........:......................... <br /> � <br /> Distance to nearest: Well_.-_.='................ ... ..............Foundation.--- .:.. __. ' .....Prop. Line----..--. ----.._...--_.-..'�# <br /> LEACHING LINE ( ] No. of L nes ... .............'...-".`.Length of each line-------..----------------- -.. Total Length .....-------------............---------�E <br /> 6X/S7-111V6 'D' Box �1........Type Filter Material...... -Filter Material...........................--.--. -----............... <br /> --...- �--� <br /> Distance t)nearest�Well�--._, -'.;,Ir -.}-....Foundation............................Property Line..----_.._-__.............. <br /> ,! :�' .- � <br /> SEEPAGE PET ( ] Depth...._....!r...�:_Dlameter.....................Number;A..--------.----.-------..-.- Rock Filled Yes ❑ No <br /> ,I l , <br /> EXIST/,V6 Water Table Depth---- . ---- r�... :.... - Rock Size.-... ----•----------------- <br /> 1 , <br /> Distance toynearest: Well..._'"_.-- ................Foundation.--------..---..----------Prop. Line.--.......-..--.----..._... <br /> REPAIR/ADDITION (Prev. Sanitation Permit#-----. '6 Z_--.-Y. :-- .Date.-----9u�� �� <br /> . --..------.. <br /> Septic Tank (Specify Requirements)- <br /> --------------------- - . ..... ---- �..,,.-. ...�• = = <br /> Disposal Field (Specify Requirement�)_E'.USrA�G3 �SE� _,6 P/ - Tl` G�G Co•d�/�C77or[/5 <br /> r <br /> ---------------- - ----- ------••------... -----.. ...... <br /> -------------------------------- _ <br /> (Draw exa`Ing and required addition on reverse side) <br /> I hereby certify that I have prepared this !ipp ication and that the work will be done in accordance with San Joaquin Cbunty p <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health. District. Home owner or licensed agents i <br /> signature certifies the following: 4- \t <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as <br /> to become subject to Workman's Com ensatio'n'Ip�iv`s oF'Ca'lifor'nia.""' `t" G` `e <br /> Signed------- ------ --�-- - - .`....------- -. ------------- - --------------- ---- <br /> By.. X' e `' `�.. ...... - •- --------------Title.......... <br /> �--STlC ..... <br /> --------------- <br /> (lf other than owner) <br /> FQ DE ARTME T USE ONLY <br /> APPLICATION ACCEPTED BY. .... - ............................DATE <br /> DIVISION OF LAND NUMBER. - <br /> ........_._ -------- <br /> .....DATE- - ------------------------- ----------- <br /> ADDITIONAL COMMENTS----------- --- --- --- ------------•------ <br /> ---------------------------- ••-------------------------- ----------------------------- -•--- ------ .........._... <br /> ------------------------ ------------------------ <br /> Final�InspecTion by::.................... . Date.... - <br /> ::----- ......--- -- •------------------ ------:----- - -::-- ---.-...... <br /> EH 13 24 + 'SAN JOAQUIN LOCAL HEALTH DISTRICT } FRS 21'677 REV. 7/76 3M <br />