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FOR OFFICE USt: <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ---------------------- ------ -- -------• Triplicate) Permit No...�. _- C <br /> (Complete in <br /> - ----- Date Issued-,.5—?9This 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 /> Ordinance No. 549 and existing Rules and Regulations: <br /> This application is made in compliance with County <br /> JOB ADDRESS/LOCATION:.: -.-vU '..[JC}_Vll. ..1.�°\.9.._ .: ------------------ -----.CENSUS TRACT.. <br /> Owner's Name.... . f2 Y.-�.�.r.Q_.w.: :.. - _. ti, : Phone <br /> qg .'. <br /> Address_A. __VV........ <br /> Contractor's Name------ ............. .... ------- •----- -...- <br /> License..#---- --------- ----- ---- ..Phone ----------- ----- ------ <br /> = <br /> Installation will serve: Residence Apartment House El - Commercial ❑ Trailer Court ❑ _ <br /> Motel ❑ Other..j ----- -- _-----------_-------- <br /> Number <br /> ------ --_------Number of living units:..........{.....Number of bedrooms......7...Garbagp Grinrl&r•-------------Lot Size__.....:......... ....... <br /> ----- --------•-----Priva <br /> Y -—­,_ ..__4- <br /> Character <br /> Y Y <br /> .. te� <br /> Character of.soil to a depth of 3 feet: Sand ❑ Si . ❑ r6y-D-- ❑ Loam ❑ <br /> Water Supply: Public System and name -- ... . _ <br /> ? t Cla Pea Y YP Sandy Loam---- -- Clay <br /> Hardpan ❑ Adobe ❑ Fill Material If es, 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 /> - -- - - --Liquid Depth-------- --------- <br /> PACKAGE TREATMENT [ ] SEPTIC-TANK [ ] Size.._ :; -----..--.- --- . ..--- <br /> - <br /> ----A <br /> P ) �-, <br /> ....... . .... ......TYPe----------- -. --- Material- No. Compartments......_. , <br /> - ---------- -- _......Foundation.......... - ............-Prop, Line-------------- -- <br /> Distance'to nearest: Well....-----'- ' ..Total Length -------------- <br /> -• --.-..... ---�---- •� <br /> LEACHING LINE [ } No, of Lines ----------_--..............Length of each line -_------------- g <br /> D' Box.. Depth Filter Material...-----.-:-- ----.. <br /> ......... Type Filter Material.......:::..:° -_.; <br /> ` ----PropertyLine.. <br /> Distance to nearest: Well-....r........__---.------ Founda#ion-------------------��-- , <br /> SEEPAGE PIT [ ] Depth----- --- '-....Diameter.........:..........Number------------------------------- <br /> Rock Filled Yes ❑ No <br /> Water Table Depth-- ---- --------- . --,- _-----------Rock Size------- .......... .....--- ......-- <br /> Distance to nearest: Well_----- ji i <br /> � 1 <br /> ` � ..........Foundation------- ------�- ........Prop. Line-------------- <br /> Date <br /> --- ----- -------- .... <br /> - ...Date--- -•-••---- - I f. <br /> REPAIR/ADDITION (Prev. Sanitation Permit#------------------------------- - 1` <br /> ,r tom/ d4r�c�..�--------- - ---- <br /> �-- -------------•----- ---------cam►-�---...-_..._ .. - <br /> Septic Tank (Specify Requirements)_ - tea' '' ' <br /> Disposal Field [Specify Requirements)._............--•-_-_ ..------..........---.........------------------------------------ <br /> (Draw existing and require- i --- v s <br /> - <br /> 1 d 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 County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Horne 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, I shall not employ any person in such manner as <br /> to become pubject to W man's Compensation laws of California." <br /> Signed-- -. ---- ....--- Owner <br /> - ....Title- -- --- -------- ------- -------- ------- -------- ---- <br /> (If other than owner) <br /> F RD ARTMEN ONLY <br /> DATE .....--- -- <br /> APPLICATION ACCEPTED_. `BY---- --.:-- - - <br /> ... <br /> �� ^'�--.--.�. -�- - ` -- - ------- --------- -----------------DATE-- -- ----- ---.. .- - - -- - -......_...... <br /> - -- ------------- <br /> �._.. . <br /> ADDITIONAL COMMENTS......... <br /> . . --- <br /> DIVISION OF LAND NUM .-- <br /> _.. <br /> ----------- ------ <br /> -------- - <br /> -----••--------------------------- ........ --- . . -r'�-- ---- -----•---------- ---- --........ ... ----- --------- ----- ------ --Date._. _r��--79--- -.....--- <br /> ._... <br /> Final Inspection by _ ._. <br /> -- ------- - <br /> F85 21677 REV�6 3A <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT <br />