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FOR OFFICE USE: <br /> FOR OFFICE USE: <br /> r^ -.• .,� w ,APPLICATION FOR SANITATION PERMIT q <br /> -- ,. Permit No./5�1 <br /> .• I , <br /> --,------�; ----}-- - -'_":_, •" __.---�I_--- �, (Complete in Triplicate}*�' <br /> --------------- ----------- ----�----- - - � Date Issued._/0-.3�-_. <br /> �- This Permit Expires 1 YecYFrom Date Issued <br /> -------------------------- - <br /> y. <br /> Application is hereby made #ol�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 /> r <br /> JOB ADDRESS/LOCATION__.- _ ""kyr �_r� .C� 3-----� CENSUS TRACT. - <br /> f_ -.----.---Phone----------------------- - --- <br /> ) �, / .L <br /> Owner's Name ---- -----= ---- ----- - �---�--------------------------------------------Sf . <br /> v 7� <br /> Address----16 .17�: .f4�` : s{✓ _�'ff. __ d City Zi � <br /> --- <br /> 2 <br /> Contractor s Name--------RIC), <br /> License #s.��--- 8�--- Phone -- <br /> Apartment House Commercial ❑ Trailer Court ❑ ; <br /> ❑ ; <br /> Motel P Other---w:::-= _ .. <br /> Installation will: serve: Residence ❑ � - r F <br /> Number,of living units:"-_.4-_-- Number of.bedrooms._ ----Gar ge Grinder_ _ Lat Size !" - <br /> v K / d <br /> - � : ---- Prrvater❑ <br /> Water Supply_ Public System and'name-- -----:- -------------- - -. ---: - ; <br /> ' <br /> Character of soil to a depth of 3 feet: Sand ❑ 'Silt E] Clay ❑ , Peat E] Sandy Loam ❑ Clay. Loam ❑ ! <br /> ' Hardtari 0 Adobe Fill Material_.._";------If yes, type------------------------=---•--- <br /> ' <br /> (Plot plan, showing size of to , location of system in relation to wells, buildings et must be placed on reverse side.) C: <br /> NEW INSTALLATION: (No septic tank"or seepage .pit permitted if public sewer is available within 200 feet,) <br /> �� r..-- - �`.. Liquid Depth '�`_._/ ` <br /> PACKAGE TREATMENT [ ] SEPTIC TANK' Size-:4_-"- --#- i. - <br /> , - _ No.Compartments--------------- <br /> e MaA _ _Capacity/ ��V = ' t <br /> Lam,.,w. � °:Founda,tion_ d -----."Prop. Line_ -. �s�---------- <br /> Dist nce to nearest: Well----- 0� ------------- <br /> 70 <br /> ---- - -- , <br /> �I ^� i { <br /> LEACHING LINE' [G]f No. of Lines_ -------- <br /> L <br /> :-.Length of.each.Lina_ �_ __.- =---.Total Lefgth--______�?r-_ ------------------- <br /> ' D' Blox_.:-- ;Type Filter Materiol4•1%; Depth Filter MaterYa _.`r --^----'------ { <br /> -- <br /> Di stance to r1earest: Well"--�����_____.,Foundation_. --------------------Property Line--`_?.___.� <br /> �� /U R Y <br /> �hT [t.}' Depth_ CP - ..Diameter - ---.Number-----------------------------------_• <br /> No <br /> - <br /> S Water Table De th '.�' - = �'---- Rock :Size <br /> ' es <br /> Surnp <br /> �M ' <br /> 'Distance;to nearest: Well--------------------- <br /> -.----`-------- -"•.--------- ----Foundation t, Prop. Line--------------------------- <br /> REPAIR/ADDITION (Prev:Sanitation Permit#-------- -=---- ------------- -----.Date------------'---------------------------------1. <br /> o d , .L � _..C„ --- <br /> ------ 9 --. ----q <br /> Septic Tank (Specify Require i ents)_-- ." �-_-- ��-�----�- --- f - g <br /> Disposal Field (Specify.Requirements)--------------f7�- <br /> :.. P ---------------------------------------- : ----------- ---- ------ ..---------- ------------ <br /> -- <br /> -=------ --------------------- : -------------------------------------- <br /> -- --- ------'-------------------_---- ---------- <br /> ---- --------- ---------------- <br /> (Draw existing and're- uireaddition <br /> .on reverse side) <br /> I hereby certify that oI have <br /> I <br /> d prepared this application and that the-work wi}I be done in accordance with San-Joaquin County <br /> f Regulations of the San Joaquin Local Health District, Home owner or licensed agents <br /> Ordinances, State Laws, and Rules and <br /> signature certifies the following: <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 beco �sb t to W IkmaJri15 Compensation laws of California. <br /> Signed_,- L'o-@9'�'�.- ---------- --=- Owner <br /> f xop <br /> l l f <br /> ________________________________________ <br /> --.................Ti#1e ____________ . , <br /> .+. t <br /> -------------- {If other than owner] ; <br /> �101111 EPARTMENT 7_ <br /> USE ONLY <br /> _.DATEAPPLICATION ACCEPTED BY____ -0 : - -- - ------------------------------- <br /> DATE - <br /> DIVISION OF LAND NUMBER------------`' ---------- ----- -------- <br /> ADDITIONAL' <br /> ------ - - . <br /> ADDITIONAL COMMENTS.��i----- `,rao�. ------ Y1 �� ------- w.Ll_s'.,:(2 _n'1,54L6 tri_Srzry ,S� =----- -------- ------- <br /> i zknm r1E c <br /> ------- ------------------ <br /> # .�. � �--N.2:��----�ermr_f_.L1.��L!_i�--------- -�'----=�--:--'�-`-=_--"i'.�n�-- ---------- ---- <br /> ------ --------------- ---------- ------=------------------------------------- -------------- <br /> r ----------- --------- - ���?�-------------------------- <br /> ------------ <br /> - <br /> Final Ins ectiom b ��---------------- --------- -------- -------- <br /> SAN JOAQUIN LOCAL HEALTZSTRICT Fas 2i6» REV, 7/76 aM <br /> EH 13 24 _ �� � �. <br />