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FOR OFFICE USE: FOR OFFICE USE: <br /> f <br /> `APPLICATION FOR SANITATION PERMIT <br /> Il (Complete in Triplicate) Permit No------- <br /> Date Issued________ ___________ <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 /> JOB ADDRESSAOCATION--- -- 6 � 1�--_Sj, _-S C1t --•---- f/ `-._.CENSUS_TRACT - --------------_-- <br /> Owner's Name----- 13 V k T = i :. : Phone vZ 4 ---- <br /> c <br /> -- .� i. <br /> Address a A ----- ----I. . _ City l zip <br /> Contractor's Name ' G� = -----License #�f �5 Phonea _�"l(� "--- <br /> Installation will serve: = esidence Apartment House.❑ Cornmercial•❑• T- allereCourt <br /> 1 ' <br /> .. . Motel�[»�# Other_ Ae-." <br /> F. Q E <br /> Number of living units:_, Number of,bedroo s�----Garbdge.Grinder. -_Lot Size------------------ -------------- .__. <br /> Water Supply: Public System and�name._---------------------------------------------` ------F------=------------_------- ----------------------------------- ---------Private <br /> Character of soil to a depth of 3 feet; Sand ;Silt q�Cla Peat Sand Loam Clay Loam { <br /> P.. ❑ ❑ �.YQ _ ❑ y y y M W <br /> ' <br /> Hardpan ❑ Adobe Fill Matelah, �._._ IfY <br /> es, type-------------------------------- <br /> ❑ { <br /> O <br /> (Plot plan, showing size of lot, location of.Fsystem in"relation to'welis, buildings,-etc. must be placed on reverse side.) <br /> NEW INSTALLATION: - _{No septic tank:or seepage- pit-'perm tfed ifpublic sewer is available within 200 feet,] ' <br /> PACKAGE TREATMENT . ] SEPTIC TANK f';l ?'� i Sizte`=--------------------- - ------f----- -. ----------Liquid Depth'-------.- --- --- <br /> Distance. o nearest: Well------- ------'.__-- :_-:__ Foundation-- ___-- -----_----_------Prop: Line.!_..---_ -- i <br /> Capacity 3 'Type._:_.,_ = = <br /> -Material_=._-_ __ - -----------No. Compartments__ ______________ <br /> t <br /> LEACHING LINE [ ]. Na. of,, ! hes ._____.Length of each Ems._ :_,............... .----,.Total Length <br /> �.. , YA _ --------..Depth Filter Material-----=---=------=------------------- ----------------° <br /> Distarl'ceto_nearest. Well ,. t. <br /> D' Box.. _�__...,_T a Filter Material:._____,.__ <br /> r --- - -- ------- <br /> _ _.Foundation .�- ______________Property Line_.__...._- ___ <br /> SEEPAGE PIT [ ] Depth ,c e_ Diameter Number___-----_ -.---. --I Rock Filled Yes ❑ No ❑ <br /> u <br /> € Water.iT'ab`le'Depth. --------------------------------- <br /> Rock -------------------------------------------------- <br /> ---- <br /> -- c z . <br /> Distanc to nearest: Weil' Ro k Size € <br /> : '"' � F undafio op Line <br /> REPAIR/ADDITION (Prev, Sanitation.Permit# 5 � =: ---------------=--------=-=--------Date---------.r.�_ _`- a-_-:- } <br /> --------------------- <br /> �-�- -.G.. i�"'L ��"p- <br /> Septic Tank-{Specify Requirements - -"--- ' <br /> Disposal Field (Specify Requirements].,= -. "7y `---------------------,---------- '-------------------------. <br /> ----- I ----- --------- -- 4 <br /> ��i = - r w a <br /> ___________ __________-.__-_________'a_o.___....__.__: _.. F.. Y._ ;--.-.._-._ -----�---. _-.-. ------. " -_.:� _4 <br /> . k <br /> {Draw existing.and required addition on reverse_side� <br /> I hereby certify that I have prepared;this app icaton�*pnd thatahe _work will be done in accordance with San foaquin County <br /> Ordinances,{ State Laws, and mules/anda.ltegulations of-the San Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the follow.ingi Fes: 3 , <br /> pax. ��� � � �, � � <br /> ' I certify that�in�the perfortnatele of-thework For which this permit isoissued,-1 shalt not{employ any person in such manner as <br /> to became��ec.,>-to ork n s Com ensation laws of .Califo_rnia.I <br /> Signed = ] --------- -- . ----Owner <br /> BY- if other�'t ' T e - ------------------- =' <br /> ---------------------------�- -- <br /> it <br /> { than'owne`r r : <br /> .. ... ,F DEPARTMEN USE ONLY "' ' 4 <br /> APPLICATION ACCEPTED BY __Jp, ` -DATE. �� f. ._ } <br /> DIVISION C.F LAND NUMBER _ M. ........ - • ---------]---- ---------- ..DATE.---- <br /> ADDITIONAL COMMENTS --------=-- ------------------=------------------------'-- -- - " ------------------------ ------- <br /> = ------'----------------------------' ------------ ------ -------- ----------' <br /> M <br /> - --- --- --- <br /> I� ---- ----------- <br /> = ---------- -- ---------- - <br /> ---------------------------------------------- --- - -- - - --- --------------------------- ------------------------- - -------- - <br /> Final Inspection b - :-: ,.. _ _ . ._ Date -- , " <br /> . . <br /> EH 13 24 SAN JOAQUI LOCAL HEALTH DISTRICT Fas 1677 REV. 7/76 3M <br />