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FOR OFFICE USE: FOR OFFICE USE: <br /> PPLICATIOTV.FOR SANITATION PERMIT " <br /> -------------------------------------- -- ------� _kA) — N. v _ Permit No._.�7 `_5�.3 <br /> {Complete in Triplicate) <br /> -------------------------------- <br /> { Date Issued­,:-/z/,e,—,-'7.r <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 /> 00 <br /> -�� ------ - <br /> r JOB ADDRESS/LOCA I N_��._1��.5,�_ R ....... <br /> _ _ . .. LL SUS TRACT_----------___.------------------ <br /> ------------- <br /> j <br /> - <br /> Owner's Name.--- ---�--�__�_ ___- _�_^__ _�T------------------------ ,---- - --- --Phone._1- -------------- -------- <br /> 0 - --- <br /> Address ' O ------ --- - Gty -- -- -------- ---- - -- -----Zip------------------------------ <br /> Contractor's <br /> ----- ----------------- ` <br /> --'-- <br /> :- <br /> Contractor's Name --- - r�4Q' ----- --------- ---- --------License '9-- --Phone-_y�---- 0 IC/6 <br /> Instal la#ion will• serve: Residence 2Apartrrierrt House ❑ Commercial ❑ Trailer Court ❑ <br /> 'Motel 0 .-Other-----=--'----=----=---- ------ <br /> ]t ' �i // <br /> Number,of living units:-_-./-------Number of bedrooms.-,; Grinder---_.,_._.__Lot-Size.,.._,-_----- ?______----__ _____________-------------- <br /> .4 <br /> s <br /> Water Supply: Public System and name----=--------------------------------------------------------- --- --------------------------------------------------------_ ----Private <br /> Character of soil to a depth of 3 feet: ` Sand ❑ Silt❑ Clay ❑ ' Peat❑ Sandy Loam [-] .Clay Loam E] � <br /> Hardpan E] Adobe Fill Material- ----------If yes, type-------------------------------- <br /> (Plot <br /> ___ __________________________(Plot plan, showing size of lot, location of system in relation'to wells,-buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION:" "'(Nonseptic tank.or seepage pit permitted if public sewer is available within 200 feet,} r <br /> PACKAGE TREATMENT `['] )'SEPTIC TANK P< <br /> S. -4� - S_x -°'.-_---_-_:._--------------_-:.--Liquid Depth---q.__------_-_-_- <br /> Ca acit l o� o..Q____.T a _rlff-_-- __-- Material .--.__:__No. Compartments- -------------------------- <br /> Distance <br /> -_ - -_-- __- - -- <br /> , �,s <br /> P Y YP , = ; <br /> Dista + �-- �U Prop. Line . _� . <br /> nce to nearest: Well_=_ .=-._- �._....-'------- Foundation -- --------- ---- ----_ <br /> LEACHING LINE No.."of Lines-.--- ------ ---- ----- Length of each Ine..._, s::___________t_.___.Total Leng;h.�---I74___--_-_---_-------.-- <br /> D Box.=_ _"�T e Filter Material_�lAN' l e th Filter Material.:---_ _ <br /> --Type f 7 p <br /> - . <br /> ;Distance to nearest: Well- qffZ---- --- ------Foundation----Vim_.--___-_--_-----Property Line-_-.r`j---------------------_--_._ <br /> -- rr <br /> SEEPAGE PIT _ De th.__ _ __ Diameter_' 3_____:__ Number_______________________________ Rock Filled 'Yes No <br /> ef 110, <br /> Water tTable Depth---=----1Q4!p------- -----------------------=-: Rack Size-----C;? ------ ---------------- -- ] <br /> Distance to.nearest'Well--:----, ---d"--------------------_...Foundation.-----�zl. -_ -- Prop. Line-:_6 =---------.--_ _-- <br /> REPAIR/ADDITION {Prey:Sanitation Permit#------- ----------------------------------- Date.......-- ---'----------------------------------) <br /> Septic Tank (Specify Requirements)---- =_ A----------=' ---------------------- `------------------------------------------ ---- ------------------ --------------------- <br /> Disposal Field(Specify Requirements)-' . ....... .... --'------------------------------------------=-------------------------------' --------------------------- --------- <br /> --------- _ <br /> = --- - -- ---------------------------------------------------------------------------------- <br /> --------- --- - -------------------- --------- -- <br /> - <br /> f (Draw existing and required addition on reverse side) <br /> hereby certify that:l-have prepared this app]ication and that the-.work will be,done in accordance with San Joaquin County <br /> Ordinances, State Laws, and Rales'and Regulations of the San' Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: . 1 <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 become le to m Compensation laws of California." <br /> Signed.:. . SCP(� ------Owner _ <br /> f � ,_I <br /> BY r = -� - .. Title <br /> # r' , <br /> f 6 (If other thanowner) <br /> TRI�EPAIITMENT USE ONLY <br /> APPLICATION ACCEPTED BY = " - DATE. - �d ----------- <br /> DIVISION OF LAND NUMBER..---------- -=---- ----- ----------------------------------------- ------------------DATE- ---- --------=--------------------- <br /> ADDITIONAL COMMENTS- --- ----------­ ---- - ---------Z-------- y------ <br /> ------------------------------------------------------ <br /> --------------------- --------------=---------------- <br /> -----f--------------------------------------------- :_. ---- - V- - -- 1 --- -------------------- ----------------- ----=---=----- <br /> ii, <br /> ------------------------------------------------------------ --------------------------------------------------------------------- <br /> -------------------------------- ----- = - ------------------------------------------------------------------ <br /> -------- ----- ------ <br /> . . /Final Final Inspection bY:------ --.--- -------------- ----------Date <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 REV'. 7/76 Sen <br /> l <br />