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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT 7-!?p <br /> -_ <br /> ------------------- --------------- tn - <br /> (Caplete in Triplicate] Permit No.. Dozi <br /> --------------------------------------------------------- q <br /> Date issued-13:n/5 7 l <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: �» <br /> JOB ADDRESS/LOCATION !�r_'_ Q �---------------- ----- -- ------- -------.CENSUS .TRACT --------- <br /> ' _ k7 t <br /> Owner's Name--- 7.. 12 FiSCv��L C�1c� Cf� :..: _ �t- /[!7' Phone. 73 �O <br /> -- -- ----- -- - ----------------- ------- <br /> Address -----------•- = tet".` ----=--- 'iP - <br /> - <br /> Contractor's Name--'- f- ---- --------------------------- ------- .nse#_ _ �P..hone:� - <br /> Installation will:-serve: z Residence ❑ Apartment House.❑ Corrimerciaf-N Trailer Court <br /> f {. Motel Other- <br /> ------------- -- = <br /> Number of living units:-_ -------------Number <br /> of bedroo[ms -----------Garbage Grin dar .. -------Lot Size----------. <br /> Water Supply: Public System and rrn-e'_9--.-.-..-�'`�f_l- --------------------- :------:-- ----------- ----------- . ------------ . -_• --------------Priv te'[3�+., . <br /> Character of soil to a de th of 3 feet: . Sand ® Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 <br /> .- ... Kc-1 <br /> -a pan [�' a�15-6 0 Fly Md-terial--'------ y se ty-pe'--.- <br /> (Plot plan, showing size of lot, location of system in relation to wells, b iIdings,.etc. must be placlIDd on�reverse side.) <br /> NEW 1NSTALLATION:'� -(Noiseptic'tdnk or seepage pit permitted if public sewer is available witfiin\200 feet,) ! C? <br /> 3 SEPTIC TANK ['} Siie"_ <br /> PACKAGE TREATMENT [•)...z �. . --------------------------- --------- -- <br /> Liqud�Depth = <br /> YQ f <br /> _ Capacity------------- -- Type.-'-.-.---.-.-= Material---=-------------`--------No'. Compartments ------------------------ <br /> -------------------------------- <br /> ----- - <br /> Distance to nearest: Wel.l--------------- _- '---_- ------Foundation--- ----------- ----__ --.Prop. Line- ----------------------I___�° <br /> LEACHING LINE' [ ] No. 'of Limes ------ ------:-"-:---.Length of each Ise e -----'---- ------=.Total: .Length -->-------------------------------- " <br /> ,i , - -.. - -. F , <br /> - t .: _.,..,. . ... . _ . . ateal-----. 3 r --�------- a- -- <br /> � <br /> __Type Filter Material:----iI <br /> _ ----------Depth Filter M -D' Box--'------ ------- <br /> _-Ty <br /> Q <br /> Distanceto nearest: Well.`---------------------- Foundation - --------------------.ProperyLine---------------------------------- <br /> un <br /> - -------:-_- ----------- <br /> ---- <br /> i .� <br /> p,.. ' <br /> ' Water Table_be, th_-- �� _tom------ ----- - �. ------'- -Rock Filled � Yes [..��N'o [ &+- <br /> SEEPAGE PIT [ ] De ,h._ -Piam e� - -Number_ <br /> / Rock Size <br /> Distance' __-Foundatj.o -- ,---- -- .'Prop. Line--------------------- --- I <br /> [[ <br /> to ne�ir : Well. <br /> REPAIR/ADDITION (Prev. Sanitation Permit#_-' -----__._:-------------------: -------Date- --__Q)--------------- - - _-.___ <br /> Septic.Tank.(Specify Requirern'encs) --- �- ----------------------- : -------------------------- -----= ------ ------ <br /> L/ - <br /> Y q. . P --------- -------- ----- <br /> 1 <br /> P P --------------------•------------------- <br /> Dist <br /> Disposal Field (S ecif Requirements) i <br /> = --- ------ -- -= ----------- ------------------------ <br /> -------------- ------ -------- -------- --- ------ ---------- 1 <br /> ------ ---- - <br /> _-------- -------- - ------------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that.l halve prepared this.application-and-that the "work- will be done in accordance(fwith--San 'Joaquin.County <br /> Ordinances ,State Laws, and Rules -and Regulations of the San Joaquin Local Health District, Hor>i.e oweter or licensed agent I <br /> signature certifies the following: w ? : <br /> "I certify that in 'fhe performance of'the�work fol=:which this permit is is' suetl;l steal notl�eY�mp�y any person in such manner;as , <br /> to become..subject to Workman's .Compensation' laws of California.';, i <br /> 4 <br /> Signed - OWner } <br /> i <br /> 1 ' <br /> BY--------, -- (If other tha caner) Title = 1 I <br /> f�� - --- ------- -------------------- <br /> r ....... 1. . .. �. _�•� �.. .... o- �` <br /> FOR'DEPARTMENT USE ONLY' <br /> ----- ----:---------- - -------------` _DA r' - .---= < <br /> APPLICATION ACCEPTED BY = = ------ ------ TE : <br /> DIVISION OF LAND NUMBER._ --- -------- ------- -- ---- ----'--,-j- :-;--DATE----- <br /> ADDITIONAL COMMENTS 1 ----- � = /L�' '`� .- ffJ [ .__` ------------------ <br /> -------------------------------- <br /> - , <br /> i-------- ---------- -----=------=------------- --- ------ ---------------------------------- ----- ------------------------------------ -- <br /> ------- -------- ---------- - -- --- ------------------ ----------------------- -------------------------------------------------- <br /> -------------- <br /> --------- --------°----- - -------•---- -------- ----------- ------------ ----- ` r <br /> Final Inspection.b .— <br /> ---Date <br /> p Y' -- ----- ----------- --- ----- <br /> = = - <br /> EH 13 24 SAN JOAQUIN LOCA HEALTH DISTRIIC� CIO <br /> Fa5 21677 REV. 7/76 3M <br />