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FOR OFFICE USE: <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> - - ] ---------- . ._ ^ cam •s _.... - Permit No. .- <br /> -�•r - -�---- (Complete in:Triplicatel= .. <br /> -------------------------------- % ` <br /> • Date Issued <br /> _- <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 /> NSUS TRACT.------ - <br /> JOB ADDRESS/LOCATION.-.-...� - " = - <br /> /� °r P.�' Phare- <br /> Owner's Name ---�4 ------f-c--!l --` � _'r ----- � 1 � <br /> S/l s� � --- -----City <br /> Address - - ' <br /> Contractor's Name /---.--- ---- _J-- --------------------- -:=License #_- Phone_ .= <br /> Installation'wiII serve: Residence [� Apartment House.❑ Commercial ❑ Tra'iler. Court: ❑ <br /> Motel ❑ ' Other------------------------------------------------------------------------- <br /> ; 4 <br /> N�ber of living unit's;___; .__----Number of.bedrooms---P7---Garbage Grinder-.-,_---____Lot.Size- _____ _ _______ __________ '---. r <br /> Water Supply: Publi.0 System and name =------'-- -. -----------. . . --- -------- ------------ Private <br /> Character of soil to a depth of 3 feet: -µ Sand ❑ ,Silt L] Clay ❑ Peat ❑ Sand ,C ay Loam Q <br /> Hardpan ❑ Adobe`❑ Fill Material..-.;__----If yes,type -'_-----_---�=t � O <br /> i <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, <br /> .etc. must be p ace o i e. ` <br /> NEW INSTALLATION: {No septic tank`or `seepage ,pit permitted 'if public sewer'is available withir600 feet,] ` <br /> . : rSze. -- r � Depth .-!K r--}-- <br /> --PACKAGE TREATMENT SEPTIC TANK - --- "Liquid <br /> Ca ac'tYa�- _ TYpe Xt..� --Material_ ---- -No. Compartments-- ____-__v---_-__- ''---\ <br /> r <br /> k G <br /> Distance to nearest:.Wel.l...---Jz=_ ----------------- 'Foundation _/ ------ -. .___.P�op._Line--------/_---------------- <br /> !. Length of,each lin r r f <br /> LEACHING LINE No. 'of Lines_- -_--- -- 9 � .e.._��-:-,a,-�� <br /> '.Total.Length'.-__�v�/`.d � � <br /> -- n <br /> i D' Box -_ --.Type Filter M terial:`a -- Depth Filter Material--' 1�--- _ <br /> Found t ,. t .rt r .� 1 <br /> r 4 �., .... r --tel�-c:, �l <br /> Distance tai nearest: Well ____ __________ Foundation-- -�Q-- ----------.Property^'Line -------------- -_ _--. _ <br /> SEEPAGE PIT [ ] Depth ---Diameter' �r __--_:___.Number.. ' ,. - Y QRock Filled . Yes ❑ No❑ <br /> > .F ...... _... .. t. -. <br /> Water Table Depth---r-~ - --- - . Rock Size = <br /> t - - ---Foundation--`------t-- 1.Pro Line----------.---------- ------ i <br /> Distance ta`,nearest:Well-{ ------ <br /> ---------------Date =- '--.------- - ----1 <br /> REPAIR/ADDITION (Prev.Sanitation-Permit-#_-;-.___'_---. _,_-__ -�-� ---------- '---�- �- t ` <br /> Se ---_ ----------- <br /> ----------------- <br /> ptic Tank (Specify.Requirements)----- `=' -. ._-.- '_' - = =-------- _ <br /> Disposal Field (Specify Requirements} -_-'` _` - r <br /> ------------------------ <br /> F` <br /> ------------------._____.---._____-._--. _____ '~J/ ---------------------------_ __.____- _ ---- -_.-_ -------_ _- -------------- <br /> - . <br /> } --------------------------------------- -- --_� <br /> r".___-__-.--.__'__—---.--_______--_______.___------------.___--.-______.-_.____---; �----_____ <br /> (Draw existing.,and required 'addition on reverse side]' Q <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 theL Sari Joaquin Local Health District. Home owner or licensed agents., ' <br /> ya <br /> signature certifies the Following: - <br /> "I certifythat in the erformance'ofFthe work for which this permif is'issued,rI shall-not employ any person in such manner a—^ <br /> P <br /> Yo becombjye�ct to Wor man's Compensation laws .of .California." <br /> « "` - <br /> Signed.. �-.- .r --------------- _ . <br /> Owner �, v <br /> BY�-------- ----------------- -{ .- -�-� _ _ F <br /> �... `.T <br /> itIe� . r--- <br /> -(If other'thdn owner} ,fes <br /> "FOR'DEPARTMENT USE ONLY _ <br /> APPLICATION ACCEPTED BY-. - Te 6!�1 ---.- .:- DATE ff--------------------------------- <br /> ------------------ <br /> DIVISION OF LAND NUMBER <br /> . ------ - >_ s <br /> ADDITIONAL COMMENTS - 3 e_ t_ CBbi __,_ _:_0 --'.in.--�SoeF*__ .-�� <br /> s ----------------- ----------------- <br /> ----- _ I <br /> -------- <br /> ' ---------- ---- <br /> `\\j <br /> i <br /> -- Final Inspection �` �« _ ' Date 7S 221677 REV.--/'a 3;� <br /> p Y•-. <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT <br />