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FOR OFFICE USE: <br /> 9JR OFFICE USE: <br /> /APPLICATION FOR SANITATION PERMIT " <br /> Permit No._ 9is_ / //_,;7 <br /> -----------p -------- -------- ----- --- ------ : (Complete in Triplicate) <br /> Date Issued__. _-d -2 <br /> --------------------------------------- - <br /> 8� <br /> This Permit Expires 1 Year From Date Issued <br /> --------------------- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described, <br /> in compliance with County Ordinance No. 549 and existingRulesand Regulations: <br /> This application is made <br /> �i n -- �-� <br /> y - hT - ]�'._ ,.� CENSUS TRACT-------------------------- <br /> JOB <br /> --------------- ---------JOB ADDRESS/LOCATION -- <br /> ff i -_ -__•_• <br /> i � -------- hone_-.�_. ---- ---- <br />` Owner's Name -- / � jury- ---- -- -----------------: ----------------/-!� <br /> Address-. -�- Phone of - <br /> �C.! -_ Zip <br /> e <br /> ` # 'a�`'1 � .3 <br /> Contractor's Name._'_.. _,_-.�.._.�CG-��--�� �;-.:._ ----- )-- -'- L'cens ;�# . <br /> .... .+�...- ! .y. <br /> Installation will serve: Residence �` Apartment Rouse.❑ Commercial ❑ Trailer Court ❑ <br /> M <br /> ofiel ❑ Other - = t <br /> { _. Garbo e.Grind ',Lot,,Size ------ � ------------------------------------ <br /> f <br /> - -- --- --- --- --- <br /> Number of livingunits.. <br /> of.bedrooms g <br /> Private <br /> Water Supply: Public System and name _. :. . ----- ----------------------- <br /> Character of soil to a depth of 3 feet: > Sand El Silt❑ Clay 11Peat Sandy Loam -,ClayLoam.❑ <br /> Hardpan ElAdobe❑ fillMaterial_ yes, type- ------°.-- =-- --- ° <br /> (Plot plan, showing size of lot, location ofystemain relation to=wells; vildings, etc. must be placed on reverse side.] <br /> ,. . _ <br /> NEW INSTALLATION_: :(No'.septic' tfank-or-seepage pit-perr�iitied'i j, . .I <br /> sewer is a±ailable within 20a #eet,] ,� <br /> ` � Q_. _ - -: --Liquid Depth' �_1 1/ <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [-] *' Size_ : - } p� <br /> U'O T /G � Mat�rl�a{ -=- -= No. Compartmen10 f . <br /> Capacity.=: Yp; I ti <br /> 'J !9 ? , Foundation -Prop Line-,-1.574?t.--- ---- -I---- <br /> 3 . .Distance.to nearest: Wella-.i -- _•---- <br /> ti g P--------------------------- <br /> ------- t <br /> LEACHING LINE' [.] No. of Lines_. --- _._..Length of each;ine:_ �------- Total Length --_.� <br /> f { ��Ud th Filter Mater � .: <br /> D' Box.. .-_ T e Filter Material� _._ _ t FP,.� e. Line___._- <br /> Y 1 p �: # is _ _ <br /> Distance to nearest: Wel1-�h�v'__------: Foundation___. --------- --------.Prop ty rJ� <br /> -i =4 Rockilled'Yes El <br /> SEEPAGE PIT [ ] Depth.__ : i:-.Diameter_t -- -- Number.__ ; <br /> f'. r <br /> Water Table„Depth - ---- �z .t . <br /> Rock S e e '' <br /> -1 : # - ) 'Fb'�i`ndition -Prop Line <br /> .... �e4 :Date------ <br /> -------------------------.� ] <br /> e Distance to nearest: Well ✓ 1 x <br /> REPAIR/ADp1TION (prev.Sanitation Permit#K --------------- <br /> Septic <br /> Se tic Tank {Specify Requ i { ---==---- ------''----- _-'-----=_----- ----------- -------.-•----' <br /> p irements] ._ ; <br /> a <br /> "' -e`- .f . --------- -------- - --------------- - ------- ----- <br /> -4..___ _. . <br /> Disposal Field {Specify Req"irements]_____________________ ____ -�i <br /> -�: � � - <br /> - -- <br /> -- _ <br /> ...%__'_"..'�� ------------------'-q--`---- --- - <br /> -. <br /> 7 � <br /> " ,r� {D',iaw-exs`fing and reqs ired-ad�lition on reverse side] <br /> •-�--1. <br /> i a IicatinFi ani t afi-the '.work will be done in accordance-with <br /> San Joaquin County <br /> I hereby-certify that'l have-prepared this pp �,t� �,�,' <br /> Ordinances, State Laws-, and Rules and Regulations`"of the San Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the followir�g: `� i <br /> "l iertify that in She perform++ ce'of' work fbr:which this permit is issued, I shall not er►iploy any perso._- in such manner as <br /> to become subje orkman s Compenscition laws.of California.',' <br /> a <br /> G Signed.-`-'---- <br /> : .......... .. . ... . . . - Y.. .. e <br /> --- -'-- �-Titin <br /> er. <br /> :. -----------------------'--F----- <br /> } {If other than owner] 4 <br /> r1 <br /> . FOR DEPARTMENT E ONLY: <br /> - = G�`�]° = ----._DATb.---- te r` .-. - <br /> APPLICATION ACCEPTED. BY -__ . �- = ----- <br /> DIVISION ------=- - --- - -- -- ----- <br /> -----------------------------SATE _ <br /> DIVISION OF LAND NUMBER._ ____ ._. -- <br /> - - - �:- <br /> F <br /> ADDITIONAL COMMEN75------------ ------'- <br /> --- ----------- <br /> ------------ - ------------------ - <br /> [ -- <br /> =- ------------------� iia ;', - <br /> --------------------------------------- <br /> - --- - --- <br /> ----- - -- -- Date <br /> ----- -- - - - <br /> -.- <br /> - --- <br /> ---- <br /> Final Inspection _ <br /> F&5 21677 REV. <br /> EH 13 24 ,� SAN� QUIN"LOCAi EAI:T'H DISTRICT _ <br />