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FOR OFFICE USE.. <br /> APPLICATION FOR SANITATION PERMIT 7�`-,� qo <br /> 1 Permit No. <br />-........ ..................... <br /> .. ..... .. . <br /> ;(Complete in Triplicate) <br />:.......•• ......................................... <br /> Date Issued --� �...�.--.• <br />....... ... <br /> This Permit-, 0 Year From Date Issued <br /> .............. <br /> 1 <br /> described Thislication ishappl catio ereby adeiso adethecin compliance with unttytrict Ordinance Nom <br /> 549 and existing Rulesfor a rit to construct andtandt Regulat tion <br /> JOB ADDRESS/LOCATION ._....�.!2ail..IIc .^�`���'���a��;Y•���; � .•'---•.._..CEN5U5 TRACT <br /> '-'-' y- wi -.0 mss' ' i <br /> .. <br /> Owner's Name In/. Y.AAK�...................................................... <br /> ......Phone Q7•-? <br /> ''t I ... <br /> Address .... �.f. eyes ._.. -:.......--.................... ----••--• City. ..--•-•--�-* �...................._:............... ........ <br /> e.�a.'f u. <br /> "R(z�s� -S� Svc ,5 ••••. Phone <br /> Contractor's Name --- •- :._ �..: '_, � � ........ License # :3 <br /> Installation will serve;I Residence 4Apartment House❑ Cornmertia? Trailer Court 0 <br /> ' Motel ❑Other --------------- ---_---­--- ------- <br /> Number of living units:__.. Number of bedrooms _c, _.__..Garbage Gri der _._......... Lot Size . _ -•-•-••• •- <br /> ' `- ...Private [� <br /> Water Supply: Public System and name .' --------------- i <br /> -"'Character of sail to a depth of 3 feet: <br /> 2L.-Sand 01- eat;❑ ',Sandy loam Q— Clay Loam ❑ <br /> y �� <br /> Hardpan Q Adobe. ��F,iIIMat e ial!....._.�._ If yes,type ............................ <br /> e <br /> {Plot plan, showing size of lot, location of s stem-.in.relation-to wells, b�uildindgs, etc. must be placed an reverse side.( <br /> NEW INSTALLATION: (No septic tank C rse page pit permitted if public sewer is available within 200 feet,) (� <br /> PACKAGE TREATMENT [ I SEPTIC TA!9,K f ] Size.................... ---------------- .......... Liquid Depth .......................... <br /> -Ask.�3 , <br /> Capacity Type,'- W,-----. Material--------_ ---------- No. Compartments ...................... <br /> Distance to neo st:'Weipq-p-- ..Foundation .__-. Prop. Line ...................... <br /> LEACHING LINE ( ] No. of Lines _..._t Length o <br /> -- f each line-----------------........... Total Length ........................ <br /> f <br /> 'D' Box --------rn fyPe Filter Material ....................Depth Filter Material ___.................................... <br /> Foundation ........................ Property Line <br /> Distance to nearest: Well ....-•-----------•--... ........................ <br /> SEEPAGE PIT Depth "' # .. Diameter ................ Number ...................._-_..... Rock Filled Yes ❑ No (:I <br /> i Water Table Depth ................................Rock Size ------ ........ ............... <br /> Distance to nearelt: Well ........................................Foundation ..................... Prop. Line ---------............ <br /> REPAIR/ADDITION rev. Sanitation Permit# ...-.......••----........................... Date ---_--"--------------------•- - ) <br /> r - <br />( p is Tank (Specify Requirements) .......................... ..................................................... ........................................_.-............. <br /> Disposal Field (Specify Requirements) --------�e'Q-...... <br /> s� . <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, 1 shall not employ any person In such mannas <br /> as to become subject to W rkman's Compensation laws of California." <br /> Signed ....._.... - Owner <br /> B ..-..-- _ - .. ------_------------------- - Title 1��..........._....._.__.... <br /> Y <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED W.- ••............ ......... .... ...................`........................ ............ DATE ................7 _/.................. <br /> I BUILDING PERMIT ISSUED ............... .......................... ...................... <br /> ADDITIONAL <br /> vf� cp. ==-------.:::.:::-=-- .... :........-----... <br /> _ _ <br /> .................•..........------......---•'�•-...�--.................................. <br /> •--••----•-----• ......----•....••• ------'-................ <br /> ...------:. --•....... -._...gip <br /> -........ <br /> --- ,• �:........... Qat <br /> Final Inspection by: �� r-€' .r ;a, � .............. .......... e �...:. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> r <br /> 71723M- <br />