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e` FFOR OFFICE USE: <br /> OR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Y pp <br /> Permit No.- 7..- ^-'7 <br /> (Complete in Triplicate) p <br /> ------------------------------- <br /> :Date Issued--/_r-2 _..1;I/ <br /> ----------------- This Permit Expires I 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 application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: - <br /> ' -- --_._CENSUS;T <br /> JOB ADDRESS/LOCATION-- _ � - ; -- � -- --- TRACT.- <br /> ------ -- -------------------p ------------- <br /> Ow � rt <br /> ner's Name.. - <br /> - .City- 1{�� ---------------- Zip_�''` <br /> Address-----" ------ � ---------- - --------- ---- - ----- # <br /> L. ..r � License #-a !;,`-�._c� Phone--------- ------------ ----- <br /> Contractor's Name = ------------------------- <br /> w, <br /> Ilation�will wave: s Residence ❑' A' artment-House-©- -Commercial ❑ i,Trciile Curt,❑ t i <br /> Insta " <br /> Motel {Other_. -_ <br /> 4 <br /> s _.. <br /> Number of living units:._- - ;-- <br /> _-Nurriber of..bedrooms s�_.._GarbagXa.Gr.inder_- ;, .._ Lot Size_- �/-- <br /> Water Supply: Public System and'name_--.---_--__ <br /> --- ----------_ ------Private_, <br /> p h ... .... --. <br /> ti.: � ^ ��R�_------------------- <br /> p <br /> r:�;.�--- .- -_-- �,,. rte•_ �. <br /> Character of soil to a depth of 3 feet: Sand-❑'-Si it Clay ❑ : Peat� Sandy Loam NJ %\Loam <br /> " ' Adobe'❑ Fill Material._..._ -_..__If yes, type ----__----. <br /> Hardpan' ❑ f <br /> (Plot plan, showing size of lot, location of.system in relation to`,wells, buildings,i:etc must be placed on reverse side.) i <br /> w <br /> NEW INSTALLATION: lNo'septic tank or seepage ,pit permtted pub{ evv�eis available with'0 feet,) _ r <br /> iquid ------ <br /> � <br /> PACKAGE TRE�:TNiENT"'[`}"-"SEPTIC'TPNK ['] } _Size__ _-'--" -- - <br /> r ---- = <br /> 9 <br /> - Capacity = =='Typ�R;e d!R5_Mate•riGl: = No. Compartment _ <br /> { ; F 1/� r _.-.Pro ). Line-- --f--E'�'---� <br /> Distance',to nearest: Well_-. . <br /> - -- - ::Foundation . <br /> E % <br /> ' ( � =k JIF Lr ' �' <br /> LEACHING CLINE: [ }.. No. of Lines--- .-_ --'-----------.Length of each Iiraa s --`---- - - ---.Tota`l Length.__�l,r ---------------------- <br /> I --�- ----pth Filter Material__; / !r <br /> i I D,s Box:14 1 Type Filter Material.__ y- : � <br /> ;Distance to nearest: Wel! ' Foundation v _ Property Line. _ <br /> No <br /> SEEPAGE PIT [ ] Depth----------------Diameter-;.----------- : ---Number------------------ <br /> f ,. ...,.a 1_.. ... . s ... <br /> Roc Filled <br /> Roc ize f - <br /> .� Water Table Depth �-- --- ---- ---- -- -= ---- ---- ----- -- ---- <br /> k 5' - - <br /> �. . : ---------------------- <br /> 7 <br /> I <br /> Distance to nearest: Well ..._ ---- .___ __ ::.Prop, Line . a <br /> ;�f <br /> REPAIR/ADDITION (Prev. Sanitation Permit#----=-------------------------------- -----"------Date.-------------------------- - ) <br /> x r� - L <br /> Se otic T-ank`,(Specif Requirements)----- ._--- --------------------------- -=------- - <br /> ---.------'----- - <br /> ` r t '' ------------------------------------------- ---. <br /> Disposal Field (Specrfy Requirements)--- ------------- - ------------------------------------------------------------------ -- <br /> .. 1 --- -------- ---- ----- ----------------------------- , <br /> f � - <br /> e --- - . . � - <br /> P; <br /> -------------- --------------------------------------- <br /> (Draw existing and required addition'on reverse side) <br /> I hereiy certify that.'I have prepared this application and Oftatrthe work4will`be done-in accordance with San Joaquin County <br /> Ordinances; State g Laws; and Rules and Regulations of the San Joaquin-'L'oHome—owner <br /> col Health District. or licensed agents <br /> signature certifies the following: - -. al <br /> A.- - �._ <br /> certify that in�the performance of the-work for which this permit is issued, I shall not employ any person in such manner as <br />) to become-subject to or�sp!ensa.fion�l. laws_of CaliFocnia." - <br /> ' ------ <br /> ------------- ----- <br /> -- --- t-- -'- e -Z <br /> By I — --- - s ""; i <br /> Title <br /> FI (If other than 3owrier) *- <br /> FOR-DEPARTMENT USE ONLY <br /> --- - ---- --- - -- - - --- <br /> APPLICATION ACCEPTED,BY- = --- --- -- -------- = DATE. f�l �` - <br /> DIUlSlON OF_L4ND NUMBER _. �_. _._ - —` <br /> ---- <br /> � � <br /> ADDITIONAL COMMENTS------ - ------------------------------------------------------------ ---- ----------- ------------ - -- <br /> --=-- -- ----------- - --------- --------- -- - <br /> ' �---------------� '-�-`--�_-�-----------k;_tit-°"---- ---------- ------- ---------- _.. <br /> ---------= <br /> ___ _--- __4____ -------- <br /> _ _ ____ _ __ _-..---_---___----- ___ r <br /> _... _._.-;� .�_:-a""- -Date.... A_ - - ----- - ----------- <br /> Final Inspection by:._---- <br /> ----------------------------------------------- <br /> - ------------------------ - <br /> --- <br /> EH 13 24 SAN JOAQUIN LO AL HEALTH DISTRICT fas 21an acv. Ana inn <br />