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FOR FFICE•US'.,\ s g <br /> '�` �. -: APPLICATION FOR SANITATION PERMIT y <br /> {Cptnpfefsrin Triplicate) �.. Permit Nod.1.. r_ _--• -° �' <br /> ....� <br /> -^ ,......................... !--.... r : �''; This_Permit_fres II Year from Date Issued <br /> Date Issued _/0`7:_7 <br /> Applicata n.ls,hereby made to the SonJoaquinLocal Health District. for a permit to construct and install the work herein <br /> described. This application is made•in complianci;witli County Ordinance No. 549 and existing Rules and Regulations: <br /> JO ADDRESS/LOCATION �Q�14 _ f� �r";-s �JF=.:I��:.._._.%`�.�. CE - <br /> -/ CENSUS TRAGI .® 6 f <br /> _ �� -� <br /> Owner's Name ...... �� ----- .;ate �„�. ^...::: .................. ....�.�.-................................. 5_ 7 <br /> ._5_7 3 7 <br /> Address _ .�iCJC� C' C el�� '= ...:... .,:.. z`° .._. ..:.."..... City G <br /> ° - <br /> : <br /> ...........- ---- ---------- <br /> actor's Name:ContrLicense# ------------- Phone ----•---• -----------_ •--....._ <br /> instalIr <br /> lation wif serve: ► Residence fR(Apartrhent House fl Cornihercial OTrailer Court 0 <br /> ` Motel ❑Other.. ....... <br /> ' <br /> Number-of living u,nsts:s_1__.___ Number of bedrooms Garbage Grinder4 Size . --.rQ - ---- .:... <br /> ..... (/ !ot �.�� <br /> Water Supply: Public System and name -- <br /> - ............ <br /> - -•----.....--•-- ....---..._-.----:....... ............... <br /> • ....................Private. <br /> Character of soli to o depth of 3 feet:�- Sand Silt 0 Gay [l Peat❑ Sandy'!(;am 0 Clay Loam o <br /> Hardpan ❑ Adobe 0 Fill Notarial ..:°---: :.If yes,type............:.. ...... .... <br /> #Plot-pian Shong.sale olot, location of s stem in refiatian to wells, buildings, etc. must be placed on reverse side.) <br /> NEW MULLATION: (No septic tank or seepage pit'.permitted 1f`_PjkbllC sewer is available withi 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK 1 -&414 Size_. i - f �}p x�v 5 rR*C pth -•- y <br /> M <br /> quid De ...... - p <br /> Capacity --- --- Type -=__-- Mafericl.� __�A:I No. Compartments <br /> Distance to nearest.. Well ��� -" ............Foundation .......... Prop. Line .. <br /> ----------- <br /> N, <br /> LEACHING LINE 4.[ ] No. of Lines __...-�...................` Length of-each line....... s <br /> ... Total g .......... <br /> '©' Box <br /> a Length . � _. . <br /> �J , <br /> .1.....-FTypeFilter Material/l:_.?7Ko_qCDepth Filter Material A/." <br /> ., ----------- ----------------- <br /> 4 rf f <br /> ;. Distance to nearest: Well .:,�G�--•--....._.Foundation ...AP_`t•._...... Property Line ... ..f.. .. <br /> SEUAG"ff [ 1 -...• •. ---•--•-• teeter N 0 <br /> -- ---------------- stiff ._.............-•------•--•• <br /> k wxta...hpth <br /> ... ...................... <br /> -•--------•--••-••-••............... .............. PrnF <br /> : N .................. __Di i <br /> REPAIR/ADDITION(Prev. San itatioh Permit ... .. <br /> ------------------------- Date ._,..... ;.._:....•) <br /> Septic Tank (Specify Requirements). -------- ............. ._..:_._•___......_..---.... <br /> .............. ... <br /> Disposal Field (Specifykl equirer�irrntsE' -......::....:......................... --•---. -•- . <br /> } •--•--•--•-•------•. .-- •---------- -----•-•-•._.........-•--- <br /> -1p <br /> ----------------•-•-•------;•-- = �------__----------•--•-;-•-----_____-_:...____---_--•--.._.-....----•-•-•---••-------------.._........._--------;-_...........--••----.....---0 <br /> Draw. <br /> existing. <br /> required addition on reverse side) ; <br /> ;1;hereby_.certify-,,.that.A-have preparecl�thi's_applieation and:.th at- the.,work. will.,be-do .wlth. San-Joaquin <br /> County Ordinances,,State Laws, and,.Rides.and Regulatlons of the San Joaquin Local Hea'I&Dlstrict. Home owner or licen. <br /> sed agents signature ceri fies the following::,:. <br /> "1 certify that In the performance of the work•,for which this permit is issued, I shall not employ any person In such manner <br /> as to become b(ect to rk 's opens n laws of California." <br /> Signed - --- .. P.,�:. .. <br /> '' Owner <br /> By ----- --- --------- - ---------- - ... Title '.. --- � <br /> (If other than owner) 4 _ i <br /> r <br /> - - FORD _AR'fMi:NT WE ONLY <br /> "APPLICATION ACCEPTED BY ----- -- �. _ ._..._.__. DATE ..... - . <br /> - •--- ! . <br /> ------------- <br /> BUILDING' PERMIT ISSUED . ----- =----- DATE :.... <br /> y/ <br /> ADDITIONAL COMMENTS _-...tea.. _ �,F,_,�.�_.._,r�_---- .,���•,fz <br /> ------------- --------•------ <br /> ------ -----------------•------------- _. ........... <br /> :._ .. ... <br /> ...-- -- ---- --i_--- -- •-•- - --- <br /> Final Inspection by: --.---- -_-- .._Date _ .� <br /> ,,EH 1:3 24 1-6t3 ` ------------------------ <br /> � Jr�- Imo................ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8�7�t 3M <br />