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,. 7 � o Lk <br /> �t� FOR OFFICE USE: FOR OFFICE USE: <br /> _ APP-KATION FOR SANITATION PERMIT <br /> "� _t i Permit No.-7e- -� <br /> _ !'" <br /> Ccs plate in Triplicate) <br /> ------- -------------------------------- ---- <br /> Date lssued__I_-_3L"� <br /> ----------------- This 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 applicatiora4is.made • compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> rADDRESS/LOCAT <br /> = ` ENSUS TRACTJOB .,.Owam� �`----'"`, .-Phone_"g <br /> �l--- 3z& <br /> Address---------- -fL city � -- 3------------ ---- �� <br /> C �-r' Zip. <br /> �- -' License_#_ —--'- hone.: -=�A- -��=a7 ---- <br /> 's ----------- <br /> Contractor- �.� = - - -� S/7�J <br /> Installation will sarve: 4 c Residence [ Apartment House.❑ Commercial ❑ Trailer Court ❑ <br /> k f <br /> • - ��-_- Motel-®Other-- ------------- ------- ------------- - <br /> Number of living.units:-.--- --------N'Number of bedrooms..._-----Garbage Grinder -----------Lot Size_ :-_-.--_,._. <br /> Water Supply: Public System and name- -------------------- ------------------- -'�` {-SP 'vate ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑„Sandy Loam ❑ ,play Loam ❑ �1 <br /> Hardpan EJAdobe (� Fill Material___-- ------If yes, type'---------------- -- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings- e- c. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepagepit permitted if public sewer is available within 200 feet,) <br /> ._ -------------- 7 t <br /> PACKAGE TREATMENT SEPTIC TANK Size--------- ------f, -- -- -----Li Liquid Depth -\-"\�11�► <br /> } Capacity ' TYPe ------- --Moterial_._. No. Compartments - <br /> i F ndat:kor� �0 <br /> ` Distance to nearest: Well-------- ---------== -- -- -----------.Prop. Line -'S <br /> LEACHING LINE �`�] No, of Eines_"__---- .-- Length of each lina.._s't Y�__:'':_._,'----.Total Length.__l7d" ..--- """"-."---- , <br /> ✓ I c e( <br /> a 'D' Box ._.._.----Type Filter Material __ .-Depth.Filter.Mate�ial.__- ___f_- _____:__ <br /> ► <br /> j 1 Distance to nearest: Well---------------- -:_-___Foundation___ l 4'--�" 'i-__.___Property Line" ____s`±+--_ ___ ___ <br /> t- r cr . . Z <br /> SEEPAGE PIT Depth--" -----Diameter-._�.��-.__-__._Number___,__.____"-_�--_-`,: Rock Filled Yes No <br /> -' Water Table.Depth--- v c -------- =_ <br /> ^'Ro k Size <br /> f ---- . - ,_ ..- r <br /> r 0 f- � - � ------- <br /> '.- . . <br /> Distarice to nearest: Well `-----------------------------------------Foundation-_-_---=-,--,---- Pro Line------------""---- - <br /> ------.Date.-----#--- l -----cx_---- ---- <br /> REPAIR/ADDITION (Prev. Sanitation Permit#__-______.__�"-�_-"-._ ----) <br /> r 1 Cb <br /> SepticTank (Specify Requirements)----- -- -------- --------- --------------=--------------------------------------- •,-------j--------------------------- -------------------------- --------- f <br /> _ <br /> Disposal Field (Specify Requirements)--------- -- "�-----------r^ -=---------------==--= - <br /> �a d . = - <br /> -----------------�-�.--, L� �--- ��� <br /> ---------------------- ---------------------------------------------- <br /> (Draw existing and required addition on reverse side) -.0 <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. Home 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, 1 shall not employ any person in such manner as <br /> to become subject to Workman's Compensation laws of California." <br /> i <br /> >k Signed------------------ ------ ------ - - ------ ----- - ---------------- - <br /> Ownor <br /> 'Elk <br /> . -t. -` 1 Gly( .------------------------------ --- <br /> ------------- <br /> ----- 'itle---- <br /> - -- <br /> ( ther than'owner) ' <br /> a FOR`DEPARTMENT USE ONLY i <br /> APPLICATION ACCEPTED BY--------- -- ---- <br /> '. DATE - - ---- --------------- <br /> DIVISION OF LAND NUMBER --------------------- ----- DATE <br /> _ 11_ <br /> COMMENTS--- - ---------------- -------------------- ----------- ---------------------------------- <br /> ADDITIONAL <br /> -------------------------- ------ --- ---------------- --- ----------------------------- - - - ------------------------------------ -------- <br /> ---------------------------------------- <br /> - <br /> -- -------------------- - ------------------------------------------------------- ---- <br /> �.' <br /> -- - - <br /> -------- ---------------------------------------------- ----------------- ---- ------ <br /> ' Final Inspection b -LL __--__Date--___-_ -------------------------- ------------ <br /> ------------- <br /> -- <br /> --------- ---- --- <br /> P y:------:.. - - <br /> I EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT ras 21677 a vv 7 nn <br />