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FOf OF-2- 1- USE: APPLICATION FOR SANITATION PERMIT <br /> -;. <br /> .09 <br /> -------- ------------------*--------------- p p Permit No. -.7z---- <br /> ------------- <br /> . -L---�U �. <br /> - -- -- -�., - .y - ------------------ - (Complete in Triplicate) <br /> ----------- ------- -......... <br /> ---- ---- <br /> Date Issued <br /> -------_-_-------------_----_----- ------ This Permit Expires 1 Year From Date Issued <br /> 1 <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: i <br /> jj 1 <br /> -CENSUS TRACT __________________________ <br /> JOB ADDRESS/LOCATION{ ---�--Q d O�---1�1---�-------- ---------------- / <br /> Owner's Name t---t1- C�",�_ s��. -1 � 5 -----------------=-•--------- <br /> Phone _ _t2 _��0� <br /> Address _�J_ C__ ¢ ` -------------------------- City ----�kV�--------------------------------------------------- ...... <br /> Contractor's Name - -�.3G.m�. ��` ��`�:� -------------------------License # ---- -- -:-------------- Phone <br /> Installation will serve: Residence Apartment House--�Commercial- Trailer Court ;I] <br /> Mote ❑ Other u__1.3�, -- 1A <br /> Number of living units: -_ ___. Number of bedrooms �-____Garbage Grinder ------------ Lot Size ---9A----kcte--s------------ <br /> i <br /> Water Supply: Public System and name ----------�---A---- ----�-j-� ------•-------- ----------------------------------------------•-----__Private <br /> ' <br /> Character of soil to a depth of 3 feet: Sand'Q Silt❑ Peat E] 5andy Loam Clay.Loam <br /> i <br /> Hardpan Adobe,l] Fi I Material ------------ If yes,type ---------------------------- <br /> (PlotP Ian, showing size of lot, location 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 publfit��evXrkr�a�ailable within 200 feet,) Q <br /> PACKAGE TREATMENT [ ] SEPTIC TANK-[ ] Type Size_____ _ _ ~ Liquid Depth -------------------------- <br /> _- -_4:5'__>>_:_ .No. Compartments ..-_ .--.:..-- <br /> ----- _ ! <br /> I <br /> Capacity1-�_�_Q'-- T e ____________ Material_ <br /> Distance to nearest: Well <br /> -----15_Q _________________Foundation_.___'8-e:4;____-- Prop. Line ___ �_� ---.-.- <br /> LEACHING LINE [ ] No. of Lines ____ `------------- Length of each line----- �------------- Total•Length -- -- ------------ <br /> y , r �� '1 i <br /> 'D' Boxa__�Uy" Filter Material "--a -rd._.Depth Filter Material ---- - ----------------•-'----------- <br /> Distance to nearest: Well -_ _Q_S:]ti_______ Foun ation __-�S- _____-___ Property Line ---- <br /> 4 <br /> __ ___________ <br /> SEEPAGE PIT [ ] Depth _ Diameter ________________ Number .________ ----------------- Rock''Filled Yes [3 No .0 ; <br /> Water Table Depth ------------------------Rock Size -------------------------•------ ; <br /> Distance to nearest: Well ------------------------------- --------Foundation ---------------.---- Prop. Line _---______-_____------ i <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------1 <br /> Septic Tank (Specify Requirements) ---------------- ----- ------ --------,--—-- •.�---------------------------- . <br /> Disposal Field (Specify Requirements) _____---____ --------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------- <br /> - --------------------------------------------------------------- ----- <br /> ----------------------------------------------------------- ---------------------------------------- ----- <br /> ------------------------------------------------------- ------------------------------------------------- ------- - - <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done -in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the-San Joaquin;Local Health District. Home owner or licen- <br /> sed agents 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 <br /> ect to Workg7a 's �mpensat[on laws of California." _" <br /> f Owner f -/._ <br /> as to be ome sub' <br /> Signed ----- -By --------- - - -- <br /> ------- Title - -------- -------- -- ----- -------------------- <br /> - - - - - - - --------------------------------- <br /> (If other than owner} <br /> FOR DEPARTMENT USE ONLY <br /> TT <br /> APPLICATION ACCEPTED BY ` - --------------•--------------------------------------- DATE --- Z <br /> BUILDINGPERMIT ISSUED ----------------------------- --------------------------------- ---------------------------------------DATE <br /> ADDITIONALCOMMENTS --------------------------------------------- -------------------------------=--------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------- - - -- <br /> ------------------------------I,- _; Date - <br /> Final Inspection by. --1 - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> P u 0 1_'AA Rt-v- SM <br />