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FOR OFFICE USE: APPLICATION FOl( SANITATION PERMIT <br /> q v _ . �.^._ –Permit <br /> {Complete in Triplicate) <br /> ' 6.s - 1 s <br /> -------- -------- _'_ __--__________. _- __-_ This Permit Expires i Year From Date Issued Date Issued -3_ .�--_�.L <br /> ij <br /> Application is hereby made to the San Joaquin Local Health District for a permit 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: <br /> r i <br /> JOB ADDRESS/LOCATIONI.I:JJ-pp 2_��-----_�t -��G �Y- ---�2 <br /> 4-¢>__F_-- - -----_- --CENSUS TRACT -------------- ----------- <br /> Owner's Name 4i— C-0-1 <br /> � -------------- -------------- A ---•------------------ � --------- <br /> Address -------------------- <br /> I lS _ <br /> Contractor's Name-- '._k_- $A . - <br /> ----- ------ ONS------------ �------License # ��=1_I__ I�`Phone <br /> Installation will serve: Residence ❑ Apartment;House[] Commercial :❑7railer"C6urt ;❑ <br /> Motel ❑Other ------------------------- <br /> ------------ <br /> Number <br /> ----------------------- = :Number of living un its. _ •Num ber,ofbedroomsr3--______Garbage Grinderj/VA__-_ Lot Size(I --_AC __________________ <br /> Water Supply: uY i Public System and name -_________ )- �. I <br /> r --'�'----------------------- _ ------------�""'-�-- ----._:_Private <br /> -.- <br /> Character of soil to a depth)of 3�-feet: + ;Sand'n4 Silt Q Clay[ l Pe t❑ Sandy Loam El --Slay,Loam <br /> Hardpan E] Adobe Q Fill Material ------ <br /> ------ If yes, type ______.-_-_-_____#_---__._ <br /> F <br /> {Plot plan, showing size f lot, location of system in; relation,,to wel{s bui4ngslefc: inust 'be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit=permitted if public sewer is available w�ilhin 200 feet,} <br /> PACKAGE TREATMENT..[,] SEPTIC TANK f ] Size-------- -------------- ------------_------- LiquidDepth --------------------____-- <br /> CalpacitY --- --T-- ---------- Type -------------- Material-------1-------------- No. Compartments -------------------•-- 61 <br /> Distance to nearest: Well --------------------------- --------Foundation ----------------------.Prop. Line ------._..."--:-------- <br /> LEACHING LINE [ ] No. of Lines ------- ) ---- T "71 <br /> Length of eadi Eine Total Length ----------- <br /> # � \ <br /> Dis'Box _____._- Type Filter Material __________ --------Depth Filter Material --------------- <br /> I <br /> ___- __ __________________________ <br /> - ------ --- <br /> tanceto nearest: Well ------!'--------------- Foundation ------------------------ Property Line. ----------------------- <br /> E8 <br /> --------------- - <br /> a <br /> I [ ] WDepth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes [] No <br /> SEEPAGE PIT 'ter Table Depth --�____R_ -----------1-.---Rock Size ---------------------------------------------------------------------- <br /> .. <br /> Distance to nearest: Well _.-___ ________________________ _____Foundation _ ___ _________--- Prop. Line -_-___________-__ _.. � <br /> 1� <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------------- Date ----------------"-----------------) <br /> Septic Tank (Specify Regi�lirements) - ,. <br /> Dis.' osal Field (Specify Requirements) <br /> C6'VJ_.0 et w = p - A -- A r `'/I---------------------------------------------------------------------------------- <br /> _a_____ I[, _ _ _ I <br /> f, (Draw existing and required addition <br /> "-"--.-----------"--"--- -.=""-------------"---"-------- <br /> I hereby certify that I have prepared this application and that th <br /> - on reverse side). <br /> e 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 /> a9 - <br /> to F�ecom ct to Work ma 's Com ensation laws of California." <br /> Signe - ----- ---- --- � .V 6 ----- S <br /> Owner <br /> :-------- ----- <br /> By (,`c'``am r --{------� ----------- ` : Title ---- - <br /> ------------------------------ <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- __gyp__--------! ---- - ��-'t- ----------------------- DATE _ 1---•--- <br /> BUILDING PERMIT ISSUEDA-------------------------------- -- ------- ----DATE ------------------------------ - <br /> ADDITIONAL COMMENTS ------------ ---------------------------- - <br /> -------------------------------------------------------- -- -------------- ----------------------- <br /> -------------------------------------------- - <br /> r <br /> --------- <br /> -Inspection by: f SA ------------"._ __ _- -- ' -- -- - - ---- ---------------------------- `--------- -------- -------------------Date --------- - <br /> AQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'6$ Rev. # <br />