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FOR OFFICE USE: <br /> FOR OFFICE USE: APPLICATION FOR':SANITATION PERMIT o <br /> - ----------------- ---------�----— <br /> +. Permit No.� <br /> - (Complete yin Triplicate) <br /> U <br /> --------------- <br /> = Date Issueds��- <br /> / This Permit Expires i Year From Date Issued <br /> ------------ <br /> Application is hereby made to the San Joaquin Local Health Distrid,for a permit to construct and install the work herein described. <br /> This application is de in compliance with Co ty Ordinance No. 544 and existing Rules and Regulations: <br /> ' i0 S�o M (2[I'iJ�-rt.� i ". r" /� ` d l( - fJ+ <br /> !�'/ 6= CENSUS TRACT.- . -t------.-s -- <br /> ---•----------- <br /> JOB <br /> - -----J8 ADDRESS/LOCA Ne� r t -Phone-----. -• ----- ---- -- -- <br /> - <br /> ' <br /> ner's Name.. l! ��•_r./l •r�-..- k r- <br /> ,.. �-9 - <br /> - - = Z--------------------------------City 11 <br /> ip -- - -- <br /> F - <br /> -- --- .-_ <br /> Address---- -- <br /> Phone <br /> -------- <br /> ------ <br /> Contractors Name. __.. ----- ':TraIr Court <br /> Installation will,seave: Residence . Apartment.House ❑ Commercial ❑ q L` /w❑ f <br /> el-❑ Othe rf <br /> Mot r u a <br /> r- <br /> Number of.living units:-" "�..--_-_---Number of bedrooms',"__� Garbage Grinder.-_,...... �Size_--""_ _ =-- - lz�- ---------------------- <br /> Lot- =-- E - <br /> Private ra�i �- --- <br /> Water Supply: Public System and name-- -=---- - ----- -------------- -------------- ---_.- . I� <br /> ' <br /> Character of soil to a depth of 3 feet: Sand E] Silt ❑ Clay ❑ Peat Sandy Loam ❑ Clay Ladm ❑ <br /> Hardpan ❑ Adobe'❑ Fill Material-.._.-----"-If yes, type"--------------------- �? <br /> (Plot plan, showing 'size of lot, location of system in relation to wells, buildings,etc. must be placed on reverse side.) r <br /> NEW INSTALLATION: (No septic tank 'or seepage pit permitted if public sewer is available within 200 feet,) J i <br /> Li uid Depth ------- -- ---------. <br /> SEPTIC TANK [`l -. Size- --`-------=-- . ----- q P , <br /> PACKAGE TREATMENT [ ] - <br /> ` -___No. Compartments----------------`-- <br /> r . Capacity; =----=------=Type=--=-` =.- _:._---. -Material-.- -:. : <br /> Foundation- ------------ Prop.•Line...-------- <br /> --------- <br /> Distance-to nearest; Well - __,.- ------------------------- <br /> Totals <br /> Length -------- <br /> i ! • Length of each line,_..""_"_-" <br /> LEACHINGLINENo. of Lines.:-- •--------------- <br /> yFilter Materialw ------- . ----------- - <br /> �:.- Property Line" ----"- --------------------- <br /> Distance to nearest. Well " Foundation <br /> t Yes ❑ No <br /> SEEPAGE PIT" [ } .. . Depth ------- -.Diameter.. _ Number._ <br /> .., Rock Filled <br /> :. .. _ Rock Size----------- <br /> Wta-" = �' <br /> er Table:Depth ---------=---------------------- ------ d a <br /> Distance to nearest:Well-------- '------ -- <br /> Foundation--------- --F t�----.Prop.. Lin -------------- ------- -- <br /> ' --- ------ --- ----- ----Date--------'-------- <br /> ---------- <br /> - <br /> ---- --_=�--------- ------Y-.� <br /> REPAIR/ADDITION (Prev. Sanitation Permit#--_-----`--------------- a <br /> -- / Y <br /> --------- <br /> 5eptic Tank (Specify Requirements)-=--°`---_--'---' -----°------------------------------=------- s <br /> Dispo a `Field "(Specify Requlrementsl- � ' ( `� <br /> .-ems` ` <br /> --- --- --?L. -- <br /> -- ' r l� .- • --------------------"---_---------------- ---------------------------------_.-------"--------. -----------------------___--`__------------------ <br /> - .. ! __ --_._-.__--__"-"-. <br /> 'f __.-- __-."___- � afi <br /> (Draw existing and required addition on reverse side) <br /> I hereby--certify-that 1 have prepared this application and <br /> •that'the ':work will be done in,;csccordance with San Joaquin County <br /> Ordinances,' State Laws; and Rules and Regulations of the San Joaquin Local Health District.yHome owner or licensed agents <br /> signature certifies the following: <br /> 111 certify that in"the per'formance"of.the work for which this permit ie issued, I shall not employ any person in such manner as <br /> ;., to become subject,to Workman's Compensation laws of California." <br /> Signed"___ ------------------ - -------- Owner <br /> i rlll -- <br /> t <br /> f <br /> �� <br /> T'tle- <br /> �' BY F = = - -- , <br /> (If other than owner) _ ► <br /> I FOR R E <br /> --�-�-�--�--'-----��-• �DEPARTMENT-IiSERONLIf: <br /> APPLICATI <br /> '- --- ------- -------- =--- <br /> .�- __ =` ------------ - DATE <br /> ON ACCEPTED-BY- _.�' =-----'�:.-_-"' � "� - <br /> DIVISION OF LAND NUMBER---- ----- --------------- ------ ------------DATE- :--------::=----------------:.--------- <br /> ADDITIONAL COMMENTS------------ - -------- - <br /> ------------------------ -- <br /> = ------ ------------------------ - <br /> ---------------------------- <br /> 1 ---------------- ------ -- ----------- <br /> ------------------------- ----------- <br /> ----- -------= --------------- <br /> 1: ------------ <br /> t <br /> ------------------------• ------ <br /> --------------------- - ---- - -- --- ----------- ------ ---- ate - - ---- -- ----- -- -- <br /> f � <br /> Final -Ins ection b -- ----------------- <br /> p Y"---�-�--��- " ---"---- F&S 21677 REV. 7/76 3M <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT <br />