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FOR OFFICE 11SE: APPLICATION FOR SANITATION PERMIT <br /> •....................... <br /> Permit No, <br /> 7� G <br />.................. ................ .............. <br /> ..... �^(Complete in Triplicate) Date - .............. <br /> .. .......................... This Permit Expires it 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 <br /> described. This applicbtion is made <br /> ]i! in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br />� 1 y <br /> JOB ADDRESS/LOCATION :/ ., 9_.. ...:lJ1e ! _. 1._. Ial-•-----i--..—..__.-CENSUS TRACT .......................... <br /> jOwner's Name -_...fes f.S.�G- L.C. L�Ql ------_----- ---------•------_------=- ...... .........Phone <br /> Address .. �-. . _9:.._zZJr... aC-,o fJ'L4�1t1__.�1. .:.............. City -------Zr7jq—a/_................................. <br /> Contractor's Nome _......59.11 -------------------------- --•------•--•---••- ..................License # ......................... Phone .... ......................... <br /> Installation will serve: Residence Gj"Aportment House❑ Commercial❑Trailer Court 0 <br /> Motel ❑Other ------------------------ ................... <br /> ,33 . GAO <br /> Number of living units:_.___..... Number of bedrooms I........Garbage Grinder ------------ Lot Siz � <br /> e ................`................ ../._._� <br /> Water Supply: Public System and name ......-----•----------------------------------...........---------------------------------------------- ------Private [kY <br /> Character of soil to a depth of 3 feet: Sand ] Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ <br /> Ri�dpan []Adobe[��`Fill dt rare lal'`="F_•-: if yes;typ <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: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> 1r <br /> PACKAGE TREATMENT [ SEPTIC TANK [ I.re4 ®------S. ------------•------------•---------------- Liquid Depth --------,1, .---.-•------ <br /> 49 <br /> Capacity AOC)---..... Type . ._._... MaterialNo. Compartments _ ?.n.............:. <br /> Distance to nearest: Well ...•.............::.....Foundation _14?.. Prop. Line ....44.............. <br /> LEACHING LINE [i.<o. of-iines__._.. ......;._:::4r Length of each dine.__.2. ................ Total Length ...Ale........... <br /> 'D' Box .,Type_riiter, Material Depth Filter Material /4­ <br /> Distance to nearest: Well ._.. �- ........... Foundation ...r ................ Property Line .�...........I....... <br /> SEEPAGE PIT [� Depth ...40-'......... Diameter Number ..........o0C.-I...... Rock Filled Yes ®-'No i❑ <br /> Water Table Depth ....Rock Size <br /> Distance to nearest: Well ...ID.,�..........-•-••.•--.---.....Foundation ----� __.___..... Prop.-Line -- ---------- <br /> REPAIR/ADDITION(Pr . Sanitation Permit# ............................................ Date ........... .................... <br /> s <br /> Septic Tank (Speci Requirements) ---------_-_--__-------------_- ...................................... - - <br /> DisposalField (Specify Requirements) ••••••-•-•-•---•••••••--•--•--•------••---------------•-------•--•-••-----............------ -----------•------------•--------------- <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: X. 1 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 <br /> as to become sublet to Workman'p Compensation laws of California." <br /> Signed .._ .. _ _.� Lf` . -._._.,�G�1-�.. ..................... Owner , <br /> i <br /> By -------•-•-•.................................. . Title <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ..._.-- •• C- ..............DATE .......1."..�. -_------ <br /> BUILDING PERMIT ISSUED ..............}------•................. = _ ................. DATE ..._......._...•--- ................... ; <br /> ADDITIONALCOMMENTS ............... ........................................................................................................,.........:........................... <br /> . .................._------------------------------------- <br /> 1 7 b <br /> .........................._..__..__................. --. - __ - --..._.-........._...r:- ._......_.__.......__...- . <br /> Final Inspection by ...5.�,_.__.. Date �+ 7 <br /> ------••---•- ------•--•---•-..----- --•• -------•-•-- <br /> I SAN JOAQUIN LOCAL' HEALTH DISTRICT <br /> F w 13 24 i--Aa rm. Pm 71723 .14 � <br />