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X30 <br /> FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ---------------------------=� _ Permit <br /> ` �`i" (Completei k n Triplicate) , <br /> i- --- ------------------------ - ­I - '�.., Date Issued_ <br /> __-------_------------_'.------ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made tolthe San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with CounroOrdincince No. 549 and existing Rules and Regulations: , <br /> JOB ADDRESS/LOCA . N-.-. Uf,-D.. ---- ---- - ----.CENSUS TRACT-- �._... <br /> Owner's Name. { - - --------------- ayll�k Phone. <br /> r /-/__ya <br /> ., <br /> Address.-�G�l�* - + ' --------- ---- it = Zip <br /> x <br /> Contractor's Name------- A ----- �- ; ---- - •---------------------- Licensee#��+�.�'�� Phone. ��,� <br /> Instal lation"wilI serve: Residence Apartment House ❑ Commercial'D Tra ler*Court ❑ <br /> Motel ,x. t . . ' i <br /> Number of,living units: -;___ ,. __Number of.bedrooms.. Garbage Grander_, __._Lot Size _.-. � -_-----:- '--- <br /> i --� ........................... ---------------------Private ❑ <br /> Water Supply: Public System and name__.____.___.- ,.-:::---------------- <br /> Character of soil to a depth of 3 feet: Sand ❑ -Silt❑ Clay ❑ Peat El Sandy Loam ❑ 'Clay Loam E]Y Hardpan ❑ Adobe Z}/ Fill Material__ ------If yes, type- ________ <br /> (Plot plan, showing size of lot)location of system in relation to wells, obuildings,.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,) i <br /> Cal ac i <br /> ' SEP -- --- =--= ] .;A Size = 'Liquid Depth--- ---- ------------------- <br /> l <br /> r PACKAGE TREATMENT [ ]P. SEPTIC TANK -[`TYpe------------------_�---Material__________:______�.-- No: Compartments._-_._.:__._._.___._______________ � <br /> 3 Distance to_nearest:.Well--------------------- ---= -------- Fndtin--------------------------Prop. Line----------------------`---- <br /> LEACHING LINE,.. .[ .] No' 'of Lines........ -.::-,-=-.----- .....Length_of each lin&..-_-- - ,`.____:Total Length...--------------------------------- <br /> D':Box---------:--Type Filter Material----------------------Depth Filter Material--:------------------------ ------------.------- -- �5 <br /> Distance to nearest: Well-------'------:,------_-----Foundation----------------------------Property Line________._____ <br /> SEEPAGE PIT { ] Depth.y____ ________ Diameter----- ----._.._`____Number-----------_.___________________ Rock Filled Yes ❑ No❑ <br /> Water Table Depth 7 ---- ----- ---- -Rock Size------------------------- --------- <br /> i � �'_-= ter.,. ..._------------- ---- -- _ ." .... :„ ..._. _. .. r.�... ,.. � <br /> Distance to nearest:'Well-- i- --- Foundation-------------------------- Prop, Line---------------------- - - r <br /> f ____ <br /> i <br /> REPAIR/ADDITION (Prev. Sanitation Permit _- Date- "' ) <br /> Se tic Tank (Specify Re uiremalnts) - �� <br /> -- ------- <br /> - - - <br /> ements .-- .� - -- -- ....../* ------ --------Disposal Field (Specify Requir } <br /> - <br /> I� tc ----- ---------- -------- - --- ------------------------- -- <br /> M --------------- --------- ---------------------------------- <br /> .,- r <br /> :-- ------- ----- --- r i <br /> . ------ ----- --- " <br /> 'his <br /> existing and required addition on reverse side) rY : <br /> I hereby certify that I have pr�iepared.this application and that the work will be done in accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules-and Regulations of.the San Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: <br /> 6 <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 beco b'e t to W . man's Compensation laws of. California." <br /> Signed- � ;-- -- --------------_ __ Owner i <br /> BY :.Title <br /> {If other than er) . <br /> r <br /> - FOR DEPARTMENT USE ONLY ` <br /> APPLICATION ACCEPTED• BY�k -- -- ---- -------- ---------------------------------"---- ------------------------- <br /> DATE .................. <br /> DIVISIONOF LAND NUMBER p----- --------•:---- ----------------- .--------------------------------------------.-- ----------------DATE- --------------------= ----------------------- <br /> ADDITIONAL <br /> -- ------ <br /> ADDITIONALCOMMENTS.......1--------- --------------------­-------------------- -------------------------------------------=-- -------------------------------------------------------- <br /> ----------------------------------- --------------- ------ <br /> J ]II-------------------------------------- -------------------------------------- --------- .----------------:-:- ----------------------------- . ----- -------- <br /> 9� ------------------------------------------------------------ <br /> 7 <br /> �` - a _ <br /> ------------------------------------------ - - ---------- ---- <br /> Final,Inspection by:----- - _ D to � - <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTA'DrSTRICT F&s 21677 /7h 3r <br />