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FOR OFFICE USE: <br /> APPLICAT116 I:OR SANITATION PERMIT <br /> G <br /> --------- - ------- - ----------- Permit No.__- _.7--`� ---_ _- <br /> - - <br /> (Complete in Triplicate} <br /> C11, <br /> ' ja- iS'- 77 <br /> ------------------------------ ------------------------ ate Issued-'- <br /> ---- ------ - <br /> _-- <br /> ----------- This Permit Expires 1 Year From Date Issued <br /> Application is herebymade to,tli&san'Joaquin,Local Hdalth .Di'strict for,,a permit to'consttuct and install the work herein described. <br /> This application is made in compliance with County Or inance No. 549 and existing Rules.a d Regulations: R <br /> � ACT <br /> JOB ADDRESS/LOCATION -.��------- <br /> ---------------------------- <br /> ------------ <br /> --`- 4 ;VENSUSTR -- <br /> t y 7J�j Phone. _- ----- ----------------- <br /> Owner's Name dl�[�i ---: _ = --- <br /> :_ ' ---- ------------- <br /> Address-_- _ :City / Z'P � <br /> c - ---------- --------- ---- License � one <br /> Ph <br /> Contractors Name-- <br /> Installation will serve: Residence Apartment House.❑ Commercial ❑ Trailer Court ❑ <br /> tel ❑ Other ...----------------------------------------- - _ <br /> - -- j <br /> Number of living_units:---_---------Number of.bedrooms_�.__.Garbage.Grinder_.- -------Lot Size. <br /> --- - --- --------- <br /> Water Supply: Public System and name----.-----,`----::.,.., :=-----t __ Pnvat 2 <br /> e <br /> Character of—soil-'to_a`wde.pth of 3 feet: Sand E) Silt El Clay El ' Peat E] Sandy Loam ElCiay Loam <br /> + ``�`�Hardpan❑ . Adobe 0 Fill Material----------If yes, type-------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to'wells, buildgngs,`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 /> -----------Liquid id De th.;--_`�=----- ---------- <br /> PACKAGE TREATMENT [ ] ' SEPTIC TANK. ]?] . ":"` ' Size__--�.=�-I--=�-�-�-- -- q P <br /> Ca acity.�-= Maternal_ ��: ---_No.tCompartments.--:-._�-� <br /> T e <br /> € <br /> Distance to;nearest: Well:�_..1_�_Q- -�.- -�oundFa ----- --------Prop. Line-- Y � <br /> P---------- --- . <br /> - -- - tion---- � <br /> ] <br /> LEACHING LINE [.,] No, of Lines-___-. - :;------=='._,,,._,Length of­ �each-line - -------_-.---.--------Total Length./ -------------- ------ <br /> � <br /> t € w <br /> i D' Box--- li.__-.Type Filter Material---`- ! ------Depth Filter Material--�--- —. -.-- -;---- - •: • - � � <br /> ---- � -:_ .Property Line -_- <br /> ------ <br /> Distance•to 6W iinearest: Well__ Foundation . <br /> 11. <br /> {�] Depth- i ifimeter ' <br /> 33 <br /> _� ___Number_____ __ Rock Filled Yes No ❑ <br /> Water Tab a Depth----------------------- ---- <br /> �t � � ---- ---- - - ------- - -Rock Size_---- -- -- ------- <br /> Line <br /> f <br /> 6istance'to nearest:-Well"" - - Foundation ---- ------ -------Prop. Line_ -- --:--- <br /> -- <br /> REPAIR/ADDITION (Prev:Sanitation Permit# = --------------------- Date = ] <br /> E ------------- ---------------------- ------ �. <br /> Septic Tank (Specify Requirements)------ - ---- - -----=---------�-----=_-=-=---------------------=--------- <br /> ff __. -_.__ ___________________________________________________ ________________________________ _____ ____ <br /> Disposal Field (Specify Requirements)__.---- --n- ------- <br /> ------------- <br /> --- { <br /> -------------- _. <br /> ---------------------------------- ---- ----- ------------------------------------- <br /> ----------------------- <br /> t ------ ---- -------------- <br /> } ---------------------------------- ---------------------------- ---------------------:------------------------ <br /> > (Draw existlMancl required addition on reverse side) <br /> ion`and that the work will be done in accordance with San Joaquin County <br /> I hereby certify that.l have prepared this•apphcat A . <br /> Ordinances, State Laws; and Rules and Regulations of the" San Joaquin local Health District. Home owner or licensed agents <br /> signature certifies the following: t <br /> "I certify that'in the-perfortndnce of the work�for,which this permit is issued, 1 shall not employ any person in such manner las <br /> to become subject to .Workman's Compensation ''laws of California._.' <br /> -- <br /> Signed Owner . <br /> [ = <br /> c <br /> ... <br /> BY ------ = = <br /> Title------------ <br /> 3 <br /> (If other than owner) •� ( <br /> a "(FFbR DEPARTMENT USE ONLY <br /> �- -- - --- - - ------ - ----------- <br /> IAPPLICATION ACCEPTED BY_=__- - ------- - --= ------------------- <br /> DIVISION OF LAND NUMBER: ------------ --- <br /> -------DATE--.-------------------------- •-------- --------- <br /> .-- --• -- ----------------- -- -- <br /> ADDITIONAL COMMENTS---- - ------------ ----- - - - <br /> ---=-----------=- --------------------� <br /> - <br /> -------------------------------- ----------- <br /> ------- <br /> { ----------------------------------------------- ------------------------------------- ---- ------ - . ------- <br /> ------- --------- <br /> ------- <br /> - ----- <br /> ------ ------ <br /> - -- ,-/ ---------- ----- -- --- ----- --- -- --- --- --------------------- <br /> &-- -�-I <br /> __ <br /> Final Inspection b _ _ -=fit"- -�"---- `- �- ---- ---=-=---- Date �- -- ----- ----- aev / nn <br /> p Y = --- <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fos zie�� > >6 s <br />