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FOR OFFICE USI': FOR OFFICE USE: <br /> I APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> (Complete in Triplicate) <br /> �+ Date issued 1 <br /> 11119 rermit Expires 1 Year From I)oto Issued <br /> .Application i-, hrrr..hy madr to :h- :,cin Joaquin Local Health Dit',ict for a perm t to construct and +nstall the work herein described. <br /> This application is made in compliance w;th County Ordinance No. 549 and existing Rules and Regulations: <br /> {� f <br /> JOB ADDRESS/L0 AT10N .:( S-� ' �� .kr "'"'✓ !` CENSUS TRACT ' <br /> t <br /> •'I, 17. . i7�..�� miff.ts�> > .' Phone�.S <br /> Owner's Name � _ _ <br /> Address l � [C /�,�#- �� ]- /. f City 1 � 7-te-+t 2t. . - Zip. .. .......i.... <br /> Contractor's Name t?���-,,Q� Fri ��f rc� ..l�C 7"?� License # 32-J � � Phone i <br /> Installation will serve: Residence Q� Apartment House❑ Commercial C] Trailer Court ❑ <br /> ` Motel ❑ Other <br /> ' .(t O 2 c'.r–� <br /> Number of living units: . .. _ Number of bedrooms Garbage GrirdAr .. ....,lot Size. -,. .�. � - � •._• -• •i��-0 <br /> Water Supply: Public System and name.:. Private <br /> I <br /> Character of soil to a depth cf 3 feet/Sond n Silt 0 Ciav❑ Peat❑ Sandy loam d Cloy Loam❑ it �; <br /> Hardpan ffj Adobe❑ Fili Material . It y,-S.type .. <br /> )plot ;)tan, showing s+zn of lot, lo•c+tirn of system in relation to wells, buildings,etc, must be placed on reverse side.) h <br /> NEW INSTALLATION: ]No septic c tont or seepage pit permitted if public server is available within 2u0 feet, . <br /> 3w <br /> A° PACKAGE TREATMENT ( ] SEPTIC TANK )rf � Size �.r/l � •r f ...... Liquid Depth .. ..• <br /> C:.pacity /t!�d" Type < - No. Compartments. . <br /> ..... ...`... <br /> Distance to nearest; Well . .. 5 �. . .. ...... ...Foundation . �n .'. Prop. Line . f..•. . ..'E <br /> i LEACHING LINE (� No. of Lines 5 .. Length of each line...... .0 Total :ength ... kqe.. <br /> 'D' Box Type Filter Material.. ............ Depth Filter Material . ..,11...... ....... .... ... . ....... . . ....:. .. <br /> / Welltante to neares �.C. `.... •... ..Property Line .:. . .�4.�......F..... ; <br /> Di; nearest:Well - E.QO.. .. .... ,Foundation. LJ <br /> SEEPAGE PIT (►} Depth 2 S r Diameter . rr��,.r' ... Number.. 3,. ,. stock Filled Yes No❑ r' <br /> r err... .....I.............. . �./ter . =.�.�.................7 J <br /> Water Table Depth .......ems .Rock Size... r p ••�' .,.• ...' <br /> Distance to nearest; Well Foundation .. /,C_..- Aro Line 1... <br /> i <br /> REPAIR/ADDITION (Prev. Sanitation Permit#... . ... ,_..._.. ....... .....Date._. .. ) <br /> septic Tank (Specify Requiremew.t .................. . .:........ . . ....._....._._........................ <br /> Disposal Field (Specify Requirements) .. . .. <br /> ......... ........ . .. .. <br /> uire <br /> (Draw existing „ d addition on raverse sides <br /> i I.... i <br /> t? q F <br /> r+ 1 hereby c"fr t' '.« ^r-r ju 4 its iplication and t:+at the work will be done in accordance with San Joaquin County <br /> Orcl'nonc'rs, St I 't.,J rnd Regulatlons of the San Jritlquln total Health DbMtt, Home owner or lltensed ag`its ,�• <br /> slgn4t4r� rtriFi�s •i;r, foll.r.v+rrr: I� <br /> y <br /> "I certify that in th• po-fe'rmjy .^ W Fre work fir which Ih;s permit Is Issued, I shall not employ any person In such rnannorlas ' <br /> to berry».. r+bleN M"- 's r' impen9ati!w low- os California." 11 <br /> i Signed. .._ . . '.?wner I <br /> Title e4l"Ar./Z.eeI—e _.. . I <br /> „3 llf at n ov%.,ar) <br /> mt FOR WFARTMENT USE ONLY <br /> ' APPLICATION ACC _7 t _.. DATE . 8 .� <br /> DIVISION C%F Emus. i,.UM9ER DATE .. <br /> ADDITIONr,L COMMENTS i <br /> rfina`l�.Insp cr.tan by. " ... ...... Dare �r.e <br /> L&II .s. .v <br /> uAN JOAQUIN LOCM HEALTH DISTRICT <br />