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FOR OFFICE USE: <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No._..7�0��--�y <br /> ----- --------- -------- - (Complete in Triplicate) <br /> -------------------------------------- <br /> ------- -------- Date Issued -- ---- - <br /> _ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health Distrifor a permit to ct <br /> and existing Rultruct es and d install <br /> the Work herein described. <br /> This application is made in compliance with County Ordi ane _ . <br /> CENSUS TRACT-------------------- <br /> JOB ADDRESS/LOCATION.-- f f `Z -. `� <br /> Phone----------------- ----------------- - <br /> Owner's Name.- / -------- 1 <br /> -- <br /> # / ----- - Cit / r <br /> Address---- t �. <br /> �...�� .. <br /> -_ _. A / License #. ?.Phone = <br /> Contractor's Name----- - --- --- -:- 'G" - ------------- <br /> ---- M <br /> Installation will serve: _ Residence Apartment House.❑ Commercial ❑ Trailer Court <br /> L._. Motel Other = _ <br /> 1 3� er. Lot Size - M <br /> i <br /> Number of livingunits:..__../ -.....Number of bedrooms..-__._,_ --Garbage Grind Private <br /> ----------------- --------------- ----- - ----------------- <br /> Water Supp y.. Public System .and name------------------------------ - <br /> Character of soil to d depth of 3 feet: ScindSilt Material <br /> F-1 [-], Peat Sandy Loam El Clay Loam El <br /> M Hardpan Adobe E] teria.l----- ----If Yes, type----------------- -------------- <br /> w <br /> (Piot plan, showing size of lot, location of•system in relation to wells, <br /> buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: .(No'septiic tank or seepage .pit permitted if public sewer is available win 200 feet,) � <br /> I Liquid Depth-..----------------. • <br /> PACKAGE TREATMENT O' SEPTIC TANK [`} Size---------- ------ ------'-------- ---=--- 'Liq <br /> -_+:No. Compartments. (J� <br /> atenal_ p I 1 <br /> Capacity Yp ' <br /> I <br /> Di sance;to nearest: Well---------- M= Foundation----=--------- ----- -Prop. Line.-----------------•- --- <br /> { Total Length --------------------------- --------- <br /> f LEACHING LINE,. i.] - No. of Lines------ ------------ ... -..Length of -A <br /> each line--------------------------------- <br /> � ZP <br /> s, <br /> p er Material -----Pro er ---------"---- <br /> y D' Box -- --- :-Type <br /> . . ;,Line------------------------------- <br /> -Distance <br /> - ---- - ----------------- t <br /> YP Det Filter <br /> ----------------- <br /> ------------------- <br /> -- ---- -- ---- <br /> Distance to nearest: Well----------------------'----- <br /> T e Filter Materia __-._-: <br /> -� Foundation_- '.Rock Filled Yes ❑-. .Nom <br /> ' De th. Diameter_' ------ 1 . <br /> .. <br /> T ( l Table De th---------- ---- _-=------ ------ <br /> Number..___.. _- <br /> SEEPAGE PI ,�� � -� ,r 3• .r; � <br /> G —, ---- J Rock Size----------------- --------------------------- <br /> Water - F _ <br /> I Qistance to <br /> nedresf: Wel'I"_ y:;,s"_ '-----= Foundation--------------------------` fO.I? Line------------------------------ <br /> e <br /> -- ------ - - <br /> ---- -- <br /> ------- ��--`---~.•-`Date,-_ ------------------------ -- <br /> REPAIR_/ADDITION (Prev, Sanitation Permit#_.----.- ------ __ -_. .. — — � <br /> ----------------------------- <br /> ' <br /> 5eptic`Tank (Specify Requirements) -: -------------------- ---------- <br /> r-� <br /> ------------- <br /> - -- <br /> Disposiil Field (Specify Requirements)_-----�------------ --- _ , <br /> ` ---- <br /> ----------------------------- ----- ----------------------- — - ---- <br /> - ----------- ------------ <br /> .. . = � x ----------------------- <br /> E ` - ti i g q r.f <br /> Draw existin and re ui d addition on reverse side] � } <br /> 1 hereby certify that.1 have prepared this.,apphcatlon and that the <br /> -work will be done in accordarice with San Joaquin County <br /> Ordinances,! State Laws; and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> i ' <br /> signatufr-e certifies the following: t 's". <br /> i rf r ` which this permit is issued, 4 shalt employ any person in such manner as <br /> "I certify that'in the performance of-"thework for p , <br /> f to become subject to Workman's Comp nsation laws of California." ; <br /> 1 w <br /> Signed l n <br /> -- - <br /> � � `f � -= -- --- �-Title__�'--{-- ------- -- - -- -- --- ------ ------ - ; <br /> -- � �, Via' er•`ta - -- <br /> By =------ -------------------------- <br /> --`' <br /> (If'other than owrier] <br /> i FOR DEPARTMENT USE NLY <br /> ATE.- <br /> ----'--------------------- <br /> D " <br /> APPLICATION ACCEPTED BY-;----- --. <br /> • - --------------------------------DAT ----- -------------------------- <br /> DIVISION OF.LAND NUMBER ------------------------- --------------------------------------- <br /> ADDITIONAL', <br /> - - ------------ i.- <br /> ADDlT10NAL;COMMENT ------------------------- ------- - <br /> ----------------=--- ----- <br /> ii --------------------------- --___-- <br /> 1 -- — <br /> - ---------- <br /> --`------- ------------- --- ----- .. -S- <br /> D ? �ate <br /> ------------------------------- ------ <br /> Final-inspection by = <br /> F&s 21677 REV. 7/76,/ <br /> EH 13 24 SAN JOAQUIN OCAL HEALTH DISTRICT % <br />