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OFFICE USE: - <br /> ' s APPLICATION FOR SANITATION PERMIT <br /> f 1- a Permit No: - /�" Z <br /> (Co llete in Triplicate) <br /> --- 1 This Permit Ex ir} s 1 Year From Date Issued Date Issued <br /> ryt 1y/."C' QY�/N lf�il�sw<� AJC:/!�S/A.� crF' rdl Ca/�s� <br /> Application is hereby made to the San Jaquin Local Hedl'th District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADD ESS/LOCATION � �/---* --15�7,WC% X4(17 �1L"r41 ;- -I I/� CA-- -----CE SUS TRACT ------6--------------- <br /> Owner's Name ------�1r i r------- 11-- -�'l--/1�-------------- --------------- - r <br /> ]I, / --------- k Phonec ---- j/.- <br /> i Address-- e.- t--f� City /� <br /> -._• -- <br /> Contra4 's Name -./_ -}� -tg/ ""--- --�- -- _L K -------------License �5--- Phone ---- <br /> Installatid will serve: Residencel[ partment F use❑ Commercial ❑Trailer Court <br /> Mot I El' Other ---- - ------------------------------------ <br /> g <br /> --------------------------------- � <br /> ITO <br /> i Number of living units:-.,J_____" umber ojMedrooms -31. -*-Garbage Grinder 0 _"- Lot Size- .- < -------------- <br /> Water Si p�piy: Public System and me - 3--------_--------_----- ------------- ---------------------------------------------- -------------------Private <br /> Character)f soil to c depth.of 3 feet•.- Sand❑ Sift❑ Clay ❑Peat❑ Sandy Loam Clay Loam 'D <br /> ~ 1 H�rdpn ❑ AdobeJ Fill Material -N- If Yes, type --------------- <br /> plan! showing size of lot,. W.Wir4n �f system in reflation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INST�ALLATICI '. o septic tans A seepage pit p��mitted if public �w is a�v i able wi' thin 200 feet,} <br /> SAGE T i <br /> ,� REATMENT f ] SEPTIC TAN [ Size--�__'s-.X- --------------- Liquid Depth -- - ----_--------- <br /> Capacity <br /> Ca acit eS�t /�'fi'Material No. ' Com artments -_�..- <br /> r <br /> Distance to eatesf= C-.---___ --:_ --Foundation _/O-"---- -.------ Prop. Line -�-`---_--"-_--- \ <br /> LEACHIN LINE [� No. of Lines __ - �� <br /> --- a- "---- L ngth o each line- - -- Total Length 1��----------------- <br /> -- - --- ------ <br /> D' Box - -nS-- Type Filter &e`ol/-0</--------Depfh-,�Filter Material /-F------------------------------------- �1 <br /> Distance to nearest: W 'I! ------ ------- Foundation -- - r _Property Line------------------ <br /> SEI=PAGE ;Pi7 [ ] Depth -___---- Diameter _ ------ Number .__.____ - Rock Filled Yes ❑ No ❑ <br /> �: <br /> Water Table Depth- <br /> --- � 10 ----------- <br /> �. <br /> p Roek Size .-____ <br /> Distance ton ri?st`�'4fiie "F"�- -- -------------------- -----Fo ion --, ------ Pro Line -.-------------------- <br /> 1 <br /> --.-- -- -- <br /> ' DITION(Prev. Sanitation Permit# ----------------- ---_______--__-----.---- Date ---_ `� <br /> } <br /> Tank (Specify.Re Requirements) ------{�----------------------------- <br /> Septic -. ---- <br /> qI - = -- ------------- --- <br /> Disposal Field (Specify Requireme is) i;) ------- ------------ <br /> ------------- ---------------------- <br /> ---- --------- ------------------------------------------ <br /> ----------------- <br /> -------------------------------------------- <br /> -------------- - -------- ----------- - <br /> --------------------------=------------------------ <br /> (Draw existing and required addition on reverse side( <br /> I hereby ,certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certifythat in the performance of the work for which this permit is issued, I shall not empl y any person in such manner <br /> as to becte subject to Workman's Compensation laws of California." <br /> Signed --- -- --- ---- Owner <br /> ---------- <br /> ------------- Title -- 1' <br /> BY ' ------- ---- �/&� D149✓ �• <br /> - - <br /> (If oher than owner]! <br /> - FO.R_REPAIT•MENT_U.SE ONLY <br /> AcPPLICATfiON ACCEPTED BY .... i "-- <br /> -------- ---------- ----�� DATE ��'Z7-- -- <br /> BUILD1'NG-PER'M1T ISSUED •,erT�c--:------ _. ------ <br /> ADDlTIONAL COMMENTS r <br /> Final fns ion -- ---- ---- - --------------------------------------------------------------- ----------------------------- <br /> ---------------------------- --- l <br /> F -- Insp ion <br /> = Date --// 6 `------ <br /> - -- - ---- -- ---------- -------------------------------- <br /> -R <br /> --------------- --- --------------- - -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 T.-'68 Rov. 5M Y - <br />