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4;// FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ----------------...---......_... Permit No..7_?..-.5 <br /> - (Complete in Triplicate) . -$7 <br /> .....-.................._.......- - ...-_. ----- <br /> Date Issued/!.'.?.7'2 <br /> ...... ..................__- -----.._ .......-. This Permit Expires 1 Year From Date Issued <br /> L. <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> is application is made in compliance with County Ordinance No. 549 and exiis'ting Rules and Regulations: <br /> TbB ADDRESS/LOCATION...?.Sy_l - :1UL1.f �l- -t1r /k-- ENSUS TRACT <br /> / . <br /> "wner's Name_ . . CtI/ Z./_ -L'.At�.. -f.:�K,�. .. . ....Phone.. 'Q-7 <br /> .'idress......../9 ra - AX---J14ex-, ._.. f- -------- -----6ity.. a...4 _Zip---5�r,2,3:/----- <br /> Contractor's Name,,4A, ..._,/;i Ilt ----------.-------- ...-. ............... License #,9777�-t_,3?i -Phone. ,?_'rY,,. .7_ <br /> u stollation will serve: Residence Apartment House E] Commercial E] Trailer Court F16. otel ❑ Other......--------------- ---------- _....------- <br /> Number of living units:.... ---------Number of beddrroo//ms ... .Garbage Grinder. s&M5._Lot Size../�Q-.X.- 7b`..,-.�.------------ - <br /> LIater Supply: Public System and name..._..._Ir-f'�t.., --ki4ll C� -- --------------------------------- -------------------------------.Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ ilt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe Pif Fill Material.. ._ __If yes, type-------- ------------_......... <br /> tPlot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) %A <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) - r <br /> `4CKAGE TREATMENT [ I SEPTIC TANK [ ] Size..._/dPiW------------------------------------- .Liquid Depth------- _...... <br /> ._._.:. <br /> CapacityAt ---------Type _ ....-Material .. .C " No. Compartments.... ------ -----_------.0 <br /> Distance to nearest: WellfJ�d.6 � <br /> _ f{/0C..Foundation..../61_�1�_--.--.Prop. Line.... ..f..___._� <br /> �4 <br /> 4LACHING LINE I ] No. of Lines_ � -.-.. ......- .Length of each <br /> ch line �--f............ <br /> .....----...Total Length <br /> / <br /> .. ./7Q - -- <br /> e'D' Box. j.......Type Filter Materia ... __p/thFil'ter Material....---- -I........... <br /> ----- -- <br /> ` Distonceto nearest: We �/-L-AA/ undation..: f �':-----.Property Line...... `."/— -..-----. <br /> I r� Rock Filled Yes No <br /> SEEPAGE PIT [ ] Depth -125 ....._.Number_._. .-._................... ❑ ❑ <br /> Water Table Depth. - -pQ-r -- - - Rock Sizel —Z r� tCla. �O 3 <br /> .. <br /> Distance to nearest: WellA.hly- (r±f<'� .-.-Foundation__/a..Z­4"'-..-......Prop. Line--- -------- <br /> VEPAIR/ADDITION (Prev. Sanitation Permit#_......._........._------------- ---------------Date....-_.--.....__..................._.._.-] <br /> Lptic Tank (Specify Requirementsl------------------- --- -- ---- <br /> 'Disposal Field (Specify Requirements)........-------------- ---------------_- ------------ -------- - -- - .. .. <br /> ---- -- -- ------------ ....._.._._.. <br /> F <br /> - -- - ---- - -- ...._ ..... -- <br /> (Draw existing and required addition on reverse side) <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> rdinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents <br /> signature certifies the following: <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 as <br /> do become subject to s Com tion la s of California." <br /> ............ <br /> ---------.--------- Owner <br /> - ` <br /> Ly-------- -, Title.... - ._ - <br /> (If other than owner) <br /> FO DEPARTtENJ USE ONLY <br /> LPPLICATION ACCEPTED BY_ - -- . .... ---- - - - <br /> - -- _ - - -- - -- -- -- - ...........DATE .... 27 - .. _.. <br /> DIVISION OF LAND NUMBER... ---- - --- ----------------------------- ------ DATE --------- --• ... ..._.._..__. <br /> 4DDITIONAL COMMENTS...._--------_-- . .........-------------------------------- -------------------------------------_.-- <br /> ---------- <br /> ..._. - ... ... <br /> .. . .. <br /> ..----------------------------------------------- ..... --M0V2-.... -- (4 r11.............------------- ---..-.-..---------------------------....._------- ---.... <br /> _.,..V -- - - - - .._._.._.. -......... <br /> =m <br /> al Inspection by:. - - -- .... _._.Da,Te - - ? } as <br /> - - - - 21677 REV.7-06.3h <br /> EH 13 24 SAN JO/ IN LOCAL HEALTH DISTRICT GO <br />