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FOR OFFICE USE: FOR OFFICE USE.: <br /> APPLICATION FOR SANITATION PERMIT <br /> --------------------------------------------------------- <br /> d <br /> (Co npletei6 Triplicate) Permit o.___._ <br /> ---------------------- ----- --------------------------- G-/ - 7 <br /> Date Issued--' 7 <br /> --------------------------_--------_-------------_------- This Permit Expires 1 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 /> l - . 1 _ � " <br /> s <br /> -------_--- ---- ------------ <br /> JOB ADDRESS/ <br /> JLOCATION-------------- 5�,/ 11 __�_.le- =��-� �_�-y__. _k.p__ CENSUS <br /> EN U5 TRACT <br /> Owners Name...--- --- ....... =-- ---- ---- - ..... 5� Phone----------- <br /> fG <br /> ----- -c-- <br /> --------------- <br /> Contractor'Name_-.-- . lfw <br /> - CitYerZ: - -----------ZiPAddress lf-? - --=------------- -------License #45;V57 S __Phone ._ - -- <br /> Installation will serve: Residence j Apart ' nt,House.❑ Commercial ❑ Trailer Cour `❑, <br /> r - otel ❑ Ther------------ <br /> ------------------- ------'"- <br /> Number of.living units:--- -----------Nurriber of..bedrooms�;;-.__Garbage Grinder---'--------tot.Size____.1� _- _�--�::::��"��------------- � <br /> Water Supply: Public System and name--- ---: l.: _ _ - ------------- --- -- -1 ------]' Private <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt ED Clay ❑ Peat❑ Sandy,Loam Clay Loam ©! t <br /> Hardpan ❑ Adobe (] Filaterial------------If yes, type---------- --------------------- <br /> a <br /> I <br /> (Plot plan, showing size of lot, location of system in reF tion to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: {No septic tank 'or seepage pit permitted if p_ubli sewer is available within 00 feet,} <br /> i PACKAGE TREATMENT [ j SEPTIC TANK'['] - Size... ________________ Liquid Depth._-_1 <br /> Capacity j 11 '�-- -Ty --e&4S'-v Material---------------------- - P <br /> • _ � _No. Compartments - --�-----------------� <br /> Distance..to nearest:..Well__--- ___ Foundation__�p� �--I --.Prop: Line_. G r_____.__-.__� <br /> >�---- JZ <br /> - ---:--___.Length of each --1--.,------�- <br /> -._-, Length_ -f <br /> __ <br /> -------------'-- <br /> LEACHING LINE No.,ofe __-___ <br /> D' Bx - 0. <br /> ., ` ------------ -oI-------- y?a Filter MatePtFiIter Mate Fal-- <br /> Distance to nearest: <br /> Well _.Foundation__,;;U ---- -- -_S�LProperty Line.....�eo_/E-__-- ---- -_-' - <br /> .SEEPAGE. PIT [ j Depth.....-----------Diameter ' ----- ----------- "- F Rock Filled Yes (].{ No❑ , <br /> , <br /> Water Table Dep h =- + ------= ---'- :--.Rock Size --- - <br /> --_---.Pro Line_. <br /> Distance to nearest: WeII.J_ '____� ___.._'_"- Faundataon--_ . __: p. <br /> i <br /> REPAIR/ADbITION (P�cev.._Sani:tat ora Perm #_.j.. = tr� `'_ --t-----------� Date_,= ' '= <br /> Septic Tank Specify Re quirements]_f��r 2... -r°`-..�.."�.----------------- --• ------- ; � <br /> y j - ---:------- , .- <br /> Disposal Fiesld (Specify Requirements) . - `.. t y -- -- <br /> ' ------------------------- <br /> ----------t--------- --- <br /> 9! <br /> -------------------- ----------- ---------------- ------ - ----- - - --- _ <br /> -- - ------- ------- -.- . - - - - ---- -------- - ------- -- - ---- --- --------- <br /> r uired addition on revers <br /> (Draw existing and eq a side) s <br /> �i'hereby certify that l havepre aired this application and that-the work will be done in accordance with San Joaquin County <br /> OrdinaricesJ State L ws, and Rules Regulations Reg ulations of`the San Joaquin Local Health b istrict. Homeowner or licensed agents <br /> . r <br />[ signature ceiti#ies th following:l <br /> "I certify that'hi the' performan}ce'of the work for which--this'permit is issued,'l shall n,at-`employ a y person in such manner as <br /> to become subject to.. kma Compensation: I ws of California.". <br /> { b . <br /> Signed---- � Owner <br /> BY5 - T�lei-�.�- ----------- <br /> - ----------- --- <br /> If a her than owner) 4 � ..;� ' <br /> 1 <br /> •_ � OR DEPARTMENT USE ONLY' �"..._ ._::,•_._�;.;,,;��' __�� <br /> v_ <br /> 00- <br /> APPLICATION ACCEPTED J3�( d - ' -- - DATE. <br /> DIvION F LAID NUMBER------------- b\t I�: DAT <br /> 19,-?, ------------ <br /> - � �r -r <br /> ADDITIONAL COMMENTS__-._ <br /> I <br /> ------ <br /> "----------------------------------------------------------------.---------------------------_-----_.""_____._______---."__"-._-"_-_"_--_-_______.__.__"__.___----_.- <br /> __.-------- <br /> __ _________ <br /> ______________________________________ _ .-".".-.-________"._"""_"".-_-------_ -- ----_-__--_--.___._--_.___.-- --- <br /> E <br /> d ------------= w= DateFinection bY' <br /> EH 13 24 5AN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 REV. 7/76� <br /> 3M <br />