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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: <br /> I� (Complete in Triplicate) Permit No.--7.?--6------- <br /> Date Issued-.-- ��-�_�7J <br /> •---------------------- ---------------------------I�.. This Permit Expires 1 Year From Date Issued <br /> I <br /> Application.is..hereb�ade to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This appiicat..ionJi's made,iAn compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> •" ZdES@J 011-Xf-f sr/�.G 07`F� 4�CJ -. <br /> r ATION.....SoUth-_End of-".Ceda.r._Avenues Banta",---Ca1"�---. -CENSUS TRAO---------------------------------. <br /> JOB AIDRES$/LOC <br /> Owner'jName _'Ate. ill 1AIRY - ' ----` ------------------Phon x:835^1035---------- <br /> Ad <br /> - ------ <br /> c _-�f----_x_��xl�__&_--Dan".A�e_ re .--- _ <br /> y ----- --Tracy_T_��w -- ----------- <br /> Address.-._2C1.Z8-_�5�1_•_=0:edar-"Avenue".___ _�" ��"-_�. zi�. <br /> Contractor's Name FRANK FjI. SOUZA, TNCT;"}(Generral 239965 - p634-9386 <br /> Phone'" <br /> r .CASEY" CONSTRt1CTON---(fit "iter t . " 228516----- i ,6322396 <br /> License;#. <br /> Installation will serve: LResidence ❑ Apartmeat,House ❑ Commercial ❑�y�,Trailer Courts❑,. a Motel®' Other ---Qrde_--A."M3-1k.:$arn ( 1 -Bath) <br /> Nu <br /> ^i <br /> er of living units.---------------:!INumber of bedrooms ----.----.Garbage Grinder---_—�-�>�o�'Size- -__" ___.." ._____� -------------------- <br /> ------- <br /> "" "._.-_.-_____� <br /> 'h �- L <br /> Water Supply: Public System and name ----------------- t----------=---------- Private <br /> Character of soil to a depth of 3 feet: '----Sand ❑ ' -Silt El Clay r Peat' Sand, Loam Clay-Loam +� <br /> Hardpa o ❑ Adobe LiFill Material------------ yes,.type-.----_---.----.----- > <br /> (Plot plan, showing size of lot, Ocation 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 .1•I ��* V) jPi � <br /> [X]w—.,_ Size--"--------------------------------------------------------L-iquid Depth.-----.". <br /> Capacity.--12O0gal Type=---PrecastMaterial"iTor1creteNo.- <br /> Compartments <br /> .Distance,to nearest: IL" :1"_._1,5"Qie"*.z__-______ Fa ndatio 1� Pro ine Z. <br /> !" _ <br /> o <br /> it � ; p 5 pal 0 1�. <br /> LEACHING LINE [ ] No. of Lines "" _____�_ '— Length of each li 1_t.-,"__" -"-_.Total Len th -.__ 8 <br /> /� 9 Qa c�. <br /> D' <br /> Box-1.1"__-.Type Filter Material--r'��Ck"=Depth'Filter Material_.__--""" .�_ r '------_- <br /> , �_.. " s , t y <br /> Distance to nearest:,Well--1-5C ;u--f Foundation --_-_---25it -Property Line------x.25 S <br /> _v. t <br /> SEEPAGE PIT [ ] Depth____ __ Diameter -_____ Number_________'""""""" <br /> i --------------- <br /> Water <br /> _--- --- _ - Rock Filled Yes ❑ - No ❑ <br /> Water Table Depth.- f �"r- w .�.---------- -- o , <br /> rh- -- R ck Size-- -------------------------i------------------- <br /> ...il� "� 1 r ( i !p <br /> Distance to nearest: Well-----�--- ,------j--------.-""-.--Foundation-----:-..--.^`-' -------.Pro Line-------------------}-------, <br /> REPAIR/ADDITION (Prev. Sanitation-Permit#._'.""- :"".__ -w' ------4. " _ _-:Date---------- <br /> - <br /> _ -------------- <br /> i + ., <br /> Septic Tank"(Specify-Requirements)---- ----� �•- .�--.�---� - --=-----=- -- ---------------------�-----=--------- - ------------------- --------------------------- <br /> Disposal <br /> - ---- -------------•-----Disposal Field(Specify Requiremients)=- --------k ---f:--------- ----------------------------------------- ------ "-------------------- r' <br /> -. <br /> ----------------- --------- ---------------------- -- ---------- ---- --------- <br /> _ A <br /> , ; <br /> - ; <br /> (Draw exist: gland required addition on reverse side) -1 <br /> I hereby certify that l have prepac red this:applicationtand that the work will be done -in accordance with San Joaquin County <br /> Ordinances, State Laws,- and RLles 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; I shall not employ any person in such manner,as <br /> to become subject to Workman's. Compensation- laws of California.'! <br /> Signed--FRANK--F�".-S.OUZA_,�" N _...:" (Co_ r'a _tor ---------q e.r <br /> y t-Laxice---P.---_And-an o-than ow er � 1 ftp -------Secretary -------- ------------- t <br /> ,�. .. OR DEPAUMENT USE ONLY <br /> a <br /> APPLICATION ACCEPTED BY-- . =F - - '---- --------- -----DATE.-- �------ - <br /> DIVISION OF LAND NUMBER -----10------------- --- DATE--.--------- ----- s i <br /> - ----- ---------------------------- -------------------------------- :-- --- <br /> ADDITIONAL COMMENTS-----------1IP---------- ------------------ <br /> -----€--- <br /> -------------------=---------- -=-------- -------- - --- - ----- -------------------------------------.- ---------- --------------------------------------------------- ------ <br /> a I <br /> ------------------------ -------- --- -------------------------------------- <br /> Final -Inspectiori;by:__-_-- � s SAN JOAQUIN LOCAL <br /> -------------------------------- <br /> -_ Date----- = .: <br /> EH 13 24 HEALTH DISTRICT F&5 21677 REV, 7/76 3M <br />