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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR•SANITATION PERMIT <br /> -•------------•-•------•------ -- .... <br /> ` (Complete in Triplicate) Permit No.-._7 ._'� . <br /> '�� //��14 <br /> This Permit Expires 1 Year From Date Issued o.................. Date Issued_. :.5� .7 <br /> Application is hereby made to.the San Joaquin Local Health District for a permit to construct and install the work herein descri <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION %�3'oZ S, / �" 5.--- ---- ........... ---------CENSUSiTRACT •----- --------- <br /> Owner's <br /> - ---...Owner's Name._ �?,QE4Sv,�,!. .. ��7f1 - y� <br /> ---- ---- ---- - <br /> ---------------- - •--- -... - -• -------------....._................_........P one._.. ..._.......---....-- - - <br /> Address - - 85 �i!yEZ>t9Vit/............. y - -- �. _.Zi <br /> - . --- City....... TK................... . P--------- <br /> Contractor's Name.... f� .RR�Sff. ..5aw Sy 3��.._ .Phone..... ._6�,'.�16"'_- <br /> . . ----License #. .... ..... 7 - <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other------- ---------_-----___...•--......_...... <br /> Number of living units:.___ bedrooms...-3-- ......_Number of ---- Garbage Grinder............Lot Size......... ......x----- --`r-...__._._ <br /> Water Supply: Public System and name-. .........< Y ---._.-------...___....._.....__- _--__-_.Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe Fill Material------- ----If yes, type.................... W <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 /> 'PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size .... ---------_---------------------------------------_Liquid Depth-----------_-------------- <br /> Capacity------ <br /> -__..__..__.Capacity------ -------------TYPe------- ------ -- ...Material----•------------.........No. Compartments.......................---._._..... <br /> Distance to nearest: Well....................._..__...._..._.......Foundation.........._ ..........--.Prop. Line..................... <br /> LEACHING LINE [ ] No. of Lines _...................---___Length of each line -..._.Total Length _. ----------- <br /> 'D' Box........-...Type Filter Material................... Depth Filter Material...------.---------..___-._._..._--._-._.------------..._-.--__. <br /> Distance to nearest: Well-_.._•---------..---- ----_.Foundation Property Line...............__...-.-.....___-- <br /> SEEPAGE PIT [ ] Depth---- _._Diameter-._................Number......-___---_.._.___--_.-____. Rock Filled Yes ❑ No❑ <br /> WaterTable Depth.................... ------------------------------------Rock Size.................._.. --..-..-_- -_--- <br /> Distance to nearest: Well............. Foundation..........................Prop. Line....-------..__._.__....._. <br /> REPAIR/ADDITION (Prev. Sanitation Permit#.....-..--��`NF1-3------------------------Date.-----..116/6 ._......__._..._._.) <br /> Septic Tank (Specify Requirements) - ...................... ......1­­- ---------......--------- -- -- -- ••----..:. <br /> -- ....... <br /> Disposal Field (Specify Requirements)-EAls7/1`: . . 3."XTr._.! a•. ,LE/ Ef_-L✓ E- _---------------------- <br /> --.._-....-•-------•-•------------------ ----------------------------------------- ----------------------•---- ................................... -------- ................... ......... _. <br /> (Draw existing and required addition on reverse side) <br /> 1 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 /> Signed------ - -•-- - - - - --•--------- - - ---=-= - -------......----=-•------- ---..'-0wner <br /> By-•------•------•--. .... ---------------------------_Title---------EST/ 0-72P - <br /> s <br /> (If other than owner) <br /> R DEPA TME USE ONLY <br /> APPLICATION ACCEPTED BY...-- /1 "''`- CCX------------- •---------- .DATE .. L 5...7. --- -----. <br /> DIVISION OF LAND NUMBER. ---------.. DATE. <br /> ADDITIONAL COMMENTS....... .... ............-............- ... . ..... <br /> .................... � <br /> ................................. ------------------ -- ------..._..-------------- ..............--•_............................................................. -- --.. .. <br /> Final Inspection by:. --.---Date... Jr—��.�..�..� Q/ ......_.. <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 RQV. 7176 3M <br />