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APPLICATION FOR SANITATION PERMIT 77-,927/ <br /> ................................................... Permit No. .•. . . .. <br /> (Complete In Triplicate) 7 <br /> ...................................................•----• <br /> ......... This Pwmlt Expires 1 Year From Date issued .. ...ss ed .... <br /> Application Is herebya to the San Joaquin tocol Health District for a perm the work herein <br /> described. This applico on•iis made In compliance with County Ordinance No. SA9 an xisting Ruses a tions, <br /> JOB ADDRESS/LOCATI N .��/. .. ......... �SY....COY..�J .X ._. .'.°"Q.....P2 ..... . .....CENSUS TRACT .......................... <br /> Owner's Name .,i .....:2e.r`......................................... �� .Phone .............................. <br /> ,. <br /> . ............. ............ ... <br /> Address s�. .l! city <br /> ... . ........................... <br /> Contractor's Name .. . ........................ .............License # `j. l1 . Phone <br /> installation will se Residence)&Apartment House Commercial❑Trailer Court j] <br /> el p or_. _ oc <br /> Number of living uni ....._.. N r rooms -------- rbage Grinder ............ Lot Size :........... .............:..........._... <br /> I <br /> WaterSupply: Public ............................... ........................_..........................................Prwate❑ <br /> Character of soil to a 3 fe • nd❑ Silt(] Cl ❑ Peat❑ Sandy Loam.Q Clay Loam ❑ <br /> Hardpan❑ Adobe(] III Mcterlal............If yes,type............... ............ <br /> (Plot plan, showing sl of I t, location of system In rel to welts, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION No pNc tank or seepage¢I rmitted if pub c se c� abbk�eeithltt 200 feet,) WOW <br /> PACKAGE TREATM , ] SEPTIC TANK( ] Size................................. .............. Liquid Depth ..........................,,1 <br /> l_ <br /> pa ty� pe - _--. . .- . Material..........- .... .. No. Compartments .f2= <br /> Isla a to rest, Well ..._.�,<��......................tFoundA T. <br /> �..`...--.__... Prop. Line-S �..._..... <br /> LEACHING LINE [ j a. f Lines ................... Length of each line...7 . ___....._.._.. Total Length -.1 .............15 <br /> ' <br /> BOX . Type Filter Material ....................Depth alter Material ....................................._..... <br /> • , ista a to nearest, Wei! ..............•-••---... Found' on—. .... Property line ...................:.. <br /> SEEPAGE PIT [ ) epth .................... N ......... ock Filled Yes ❑ No t]> <br /> Water Table Depth ................................................Rock Size ................................ <br /> istance to nearest: Well _.....Foundation ...... Prop. Line <br /> REPAIR/ADDITION(Prov. nit tion Permit# ..._....................................... Date ..................._-------- <br /> Septic <br /> -- -_Septic Tank (Specify R ulr4 mentsl ....................._....---•--...----- -----.............................................--•---...._............._................. <br /> Disposal Field (Specs R ulromentsl <br /> ......................................... ....... ......................................................................................................................................................... . <br /> ................................................. ...........................................................-............................................................................................ <br /> (Draw exlsting and required addition on reverse side) <br /> I hereby certify that 1 he p pared this application and that the work will be daccordance <br /> one In with San Joaquin <br /> County Ordinances, Slat la , and Rules and Regulations of the San Joaquin Local Health District.Homo owner or licen• <br /> sed agents signature Corti es following: <br /> "I certify that in the orf oaf the work for which this permit is Issued. I shall not employ any person In such manner i <br /> as tobtit sub(act to ark m n' pattsatlan laws of California." <br /> Signed �.. lam' . ............................................ Owner <br /> B Title ............................................................................. <br /> Y .......................... - on....... or .................................................. <br /> (If other than ow ori <br /> FOR DEPARTMENT-USE ONLY <br /> APPLICATION ACCEPTED BY --- -- . ..........................:. DATE <br /> BUILDINGPERMIT ISSUED ........................ .............................................................................DATE ........................................... <br /> ADDITIONALCOMMENTS ............................................................:........................... <br /> ....................................................................................................................................................... .................................................. <br /> ........................................ ,c....................................... ...... <br /> - Crt_X ........................ ............................. ............ ..... <br /> Final Inspection by: .......... . ............................._...........Date .•.. .:..✓�?"' ........ <br /> Est 13 2T- 1-66 Rov. �f SAN JOAQUIN LOCAL HEALTH DISTRICT 8�7h 3M <br />