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FOIA OFFICE ISE: <br /> APPLICATION FOR SANITATION PERMIT <br /> 4 ..................d... �..._ . <br /> Permit No. <br /> - IGomplete in Triplicate) — ..7��� <br /> ................... <br /> Date Issued .,"— , <br /> as 7� <br /> -----....."....:................................•........ This permit Expires 1.Year From bate Issued ................ <br /> r Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance €th County Ordinance No. 549 and existing Rules and Regulations: <br /> f ` <br /> J06 ADDRESS/ /V.�_ - ,._ Fr: �. _:: '........... "'...CENSUS TRACT .. <br /> Owner's Name -._rt '._ . _ . .:........ ............. ........ ,....__... <br /> one <br /> Address .0.,3�*C-&), - .......C€ty . :• ---••-- <br /> Contractor's Name J.s.f. sf—... License t4` ..:............ Phone .. 1�`a <br /> -- ,7- <br /> Installation will serve: Residence Impartment House Commercial[)Trailer Court l] <br /> Motel ❑Other............... ............................ <br /> Number of living units:...... Number of bedrooms ...27:::::Garbage Grinder ------- -_ Lot Size ....n ..... <br /> Water Supply: Public System and name .... ___...Private <br /> Character of soil to a depth of 3 feet: Sand b Silt Q Clay ❑ Peat❑ Sandy Loam 0 Clay Loarnll ' <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 [ 3 SEPTIC TANKA size._ ................... ..... Liquid Depth . <br /> Capacity 1a2�___-.- Type <br /> • ---- Materialj!c.rc No. Compartments <br /> ............ <br /> Distance . <br /> Distanceto nearest: WellJ.6-0- -•-- -------•----Foundation <br /> Prop. Line -•-•--- !-;7 � <br /> LEACHING LINE No. of Lines ------ -l---------------- length o each me-._ ......... Tota! Length ............. 6 <br /> 'D' fox ............ Type Filter Material ---.Depth Filter Materia! _..../. ir.........:.................. D <br /> Distance to nearest: Well .-�. ___ Fou dation ___ <....... <br /> .l �.�'........ Property Line .....,'er: .. °`„ <br /> _CIS <br /> •nl <br /> SEEPAGE PIT Depth _r te- -__-. Diameter -- Number ............../--------- hock Filled Yesg No 0 <br /> Water Table Depth ...--•---------- ------_------...---•-•-•---Rock Size ........................--...... t�1 <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .........-•---------------_----..._.__- Date ..................................I <br /> Septic Tank (Specify Requirements). <br /> Disposal Field (Specify Requirements) .................................. ..............................................................................._:................1 <br /> --- <br /> -----------------— ---- ------- ---------- - . .. --- - - ..... <br /> ----- ...__ <br /> ...I.._..--•--••-••------ . -.----........ ..--------•---------.. ---.. <br /> •-• --•-----•-.!a <br /> (Draw existing and required addition on reverse side) ~� <br /> I :hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin �. <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:District. Home owner or <br /> licen-sed agents signature certifies the following: , <br /> t1.1 certify that in the-performance of the work for'which this permit is issued, l shall not employ any person in such manner <br /> f as tom nye able t to Workman's Cons ensation laws of California." <br /> Signed - �....... �t/�, _.�?r` E <br /> "BY -................... -------­---------1-1....................... J'itle '•-•----.----•-....._....... ........ <br /> (If other than owner) `� R <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - - - -•- DATE._. _'.. °f '. ...........:.... <br /> BUILDINGPERMIT ISSUED ............ . ...•--•---•-....--•-------... ------------- -------------------------------- ............-DATE . ....................9--------- ----- <br /> ADD€TIONAL COMMENTS __-- <br /> ----------------- _--___._______________..__ ..--___ .__.__._..____.__ ._..-.______ _.___ _ _. _.................... <br /> ---------------_--------------- AA ` <br /> Final Inspection by: .. .. ©ate /...� . . �� <br /> )tel-! 13 2h 1--68 ltev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />