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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT �a � <br /> Permit No...7�----- ------ <br /> (Complete in Triplicate) ' <br /> ------------------- <br /> Date Issued_._5--/4'-77 <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: F <br /> -- .CENSUS TRACT--------------- ----- <br /> JOB ADDRESS/LOCATION---�-�-ISI-- ------------- - ----------- <br /> Owner's Name....//6 -----.Phone <br /> i�x' <br /> ------7_(�.1 �- = ------ ------- <br /> City--- ---------------- ----------- ------------:Zip------------------------- <br /> Address :.License - ----------- --- - -'/- G- ----- <br /> Contractor's Name- <br /> se <br /> - ----- ---------- = :-L' a se #_30. /� Phone g.�fGS ,T <br /> Installation will serve: ' Residence- Apartment House❑ ' Commerc+al ❑ Trailer Court ❑yt <br /> _, <br /> 1. tel r --- ---------------"- t <br /> 1 units: �.;.. .i M t 1 ❑ Other <br /> --_: I <br /> Nuinber.of living un' s -.----- -�---- �----.Garbd ; <br /> Nurriber of bedrooms _-- Garbage Grinder-.-: .--.Lot Size --------------- <br /> - <br /> Water Supply: Public System and name - :------- ---- ----------------------- ---------------r Private k <br /> - _ ---------_--.-------- '--. .. 0-- <br /> Character of soil to a depth of 3 feet: ` Sand ❑ Si it L] Clay D'- -Peat ❑ Sandy Loa, Clay Loom ❑ <br /> e Wardpari❑ . Adobe ❑ Fill Material------._----if Yes, tyAe--,��----- '`------------- <br /> t" <br /> (Plot plan, showing size of lot, location`of,syst'errm'in-relation_to wells, buildings, etcmust be placed on reverse side.) f <br /> NEW INSTALLATION: '(No septic tank age; It ermitted'if p6 i'c,sewers available within 200 feet,] <br /> F <br /> p P g P P N <br /> SEPTIC TANK Liquid -Depth.'_______________ <br /> Size_ <br /> PACKAGE TREATMENT [ ] g ,� �--�-J�---------- --�--------- - � / <br /> Ca acit 1 -c-__—Type.__ _ ' Material,-t -�" No:=Cornpart ments----- --------- <br /> Distance'to nearest: Well.- /-�_.0-- ------Foundation.- -------- -------Prop. Line--- lam__----_ _-- <br /> LEACHING LINE <br /> Na. of Lines.__-:: of each line.--- ----Jol -----------Total Lengtk-____/_7,0-------------------------- <br /> 'D' Box--:_.1-.- -Type Filter Material------- --_-Depth Filter Material__-__1___ ------ --------- ------------------------------- <br /> Distance to nearest: Well_- �_ D------------Foundation.---.____- ---------.Property _Line---____ _ ------------------- <br /> -------T De th -------- eter3�-�'-X4 -------- -- -------- Filled Yes �' <br /> � '' P ..- umber------ - - � R N <br /> N ock o <br /> Rock Size----- ------------------------------ <br /> ----- -------------- ---- <br /> F <br /> t Water Table Depth--------------------------------------- ----------------- � - � � <br /> i Distdnce to nearest: Well = i 7~t� Foundation-:. ------------ <br /> ------ <br /> ------=--- ±_Y.Prop. Line <br /> REPAIR/ADDITION (Prev,Sanitation Permit#-----------=---------=------- Date------------- ' t ) <br /> r ----------- ---- <br /> Septic Tank (Specify Requirements)--- ---- - ---------- -- - -------------- ---- <br /> Disposal Field (Specify Requirements)--------------- --'-------------------------------------------------- ----- ------- <br /> I <br /> _ _ <br /> ----=------------------------- <br /> • - ------- -- ----------- <br /> ------------- <br /> -------------------------- ----- <br /> ------------------- <br /> = = = ----------------------------------------------------- ---- - --------------------- ---------------------------- <br /> I 4 °" (Draw existing and required addition'on reverse side) <br /> hereby certify that-) have-prepared this application and that the .workYwill.�be_done -in-accordance,wfith*San�Joaquin County <br /> Ordinances, State Laws; and Rules and 'Regula:tions of the San Joaquin :Local Health District, Home owner or licensed agents <br /> signature certifies the following: ' ` <br /> "I certify that in 'the performance of the work.for.-which,this,permit.is issued;>1,shallnot.em ploy any-personAn,such-manner as <br /> to become subject to Workman's .Compensation,..laws of California." F <br /> Signed_.. ----- --- --- ------ --------- -----------=--------------OW <br /> ( " - <br /> 7y --- ------ ------ -------- ----Title---------------------------------------- -------- --------------- <br /> (If other than owner <br /> FOR DEPARTMENT USE ONLY' ' <br /> L ----- -- <br /> APPLICATION ACCEPTED BY-- ---- DATE.---r- -J ------ <br /> DIVISION OF LAND NUMBER. ----------- : DATE <br /> ADDITIONAL COMMENTS--- - ------_ <br /> ----- <br /> ---------------- <br /> --------- -----------------=- -------------------- : <br /> ----------------------------------- ----- z ----- <br /> Final Inspection-by: r" - ----- ------ Date- -- <br /> owr j� l� <br /> EH 13 24 SAN JOAQUIN LOCAL NE L H F�71E�l6 inn <br />