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FOR OFFICE USE; n " FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT , <br /> •.. ..... ................. Permit Noll.---in Triplicate} <br /> �_.-_........ .._. <br /> l <br /> ...........................................---......_. (Compgg <br /> Date Issued'S��-.�. '__.!. <br /> ......................................................... This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to.the Son.Joaquin local Health District for a'permit to construct and_install the work herein described- <br /> This application is.mode in compliance with County Ordinance No: 549 and existing Mules and Regulations; <br /> JOB ADDRESS/LOCATION..�aQZ.L... r... E LEI F !(�•• LAI, :fk n ...............CENSUS TRACT.------------- ........ <br /> Owner's Name.... ¢ .... /fes .............................Phone.._.... :- { <br /> Address ....... LEf'�'T!q�cJ L�f/ : . ....-.Ci LUQ/ Zip-.:_ ; r <br /> Contractor's Name......f ig?�/S ..d`'_5dev.�.......... ... .. ....................License #-V?S -.3 3...Phone__..._.. - <br /> 4C - <br /> Installation will serve. Residence A a fi'tlent House ❑ _b rn rnal Trailer Cotte ❑" <br /> --Wo-tel -K---0... er_ <br /> Number of living units;................Number of bedrooms...........-Garbage Grinder....._.....:Lot Size..................... . _... .-•.----_-- " .......... <br /> Water Supply: Public System and name....-------------------.. .__ 1 .._.. Private <br /> ..._..._._�. ............ ....... ... ❑ <br /> Character of soil to a depth of 3 feet. Sand 0 Silt❑ Clay ❑ Peat ❑ SandyLdarn[ Clay Loam ❑ <br /> r Hardpan C] Adobe Fill Material.. -_-- - _ If yes, type..._..:�_..�� ...... <br /> . <br /> i {plot plan, showing size of lot, location of system in relation to wells, buildings, ete. mu \be.placed ora reverse side.) <br /> NEW INSTALLATION: [No 'septic tank or seepage pit permitted if public sewer i d�aiibblewithin 200 feet,} <br /> w <br /> PACKAGE TREATMENT [ 3 SEPTIC TANK [tom �5ize......:..._4ZX. ..��-----•-�� Liquid.bepth....................... ....... <br /> I , � No.... t <br /> ,)am -a.r.t_m. s, � " <br /> Capacity_:3 _46v"..Type---RECT-...•.Material--------- .-.--- or-/- <br /> I— <br /> `Distance to neares :•Weil_.,_......... .................Foundation- �, . _ <br /> _......._.-.._... <br /> k �0_ <br /> LEACHING LINE [1.}"— No. df--Lips -- -engih of each lina..--- too }-'.-�:Totoi`Length -.' . �'` .... """' <br /> :_ <br /> 'D' Box-.✓....Type Filter Moserial...S�_. .....Depth Filter Materials....._../._._�.`.--_-- -•• -`--_'-._._...� .• <br /> Distance to nearest: Well............................Foundation---_ _-....Property Line....•.'? <br /> Depth..p �..._Diameter..-3E?�-.-- Number_......--^3_------- "*'" Rock Filled • Ye \ Nb.❑ <br /> 77770 <br /> SEEPAGE pl7 EIrY <br /> ' ••--• \ <br /> i <br /> Water Table Depth....... Rack Size.:-- -~_.._,_ <br /> i r <br /> I ---_._...Foundation--E 1 •� ��:...Prop.' Line,:_---5-. .._.�.. <br /> Distance to nearest: Welt................._..__..........._ <br /> REPAIR/ADDITION (Prev. Sanitation Permit#....:-' -•----• •=• " ......... .....Date...1...... ;:." l 1 <br /> Septic Tank (Specify Requirements[ #. ' � rf" �+ ...\:_..., <br /> Disposal Field (Specify Requirements) '` ............... <br /> � 6...-�................. :.._ '�. • ` ?+„ ' <br /> _........._ s <br /> r <br /> � .. <br /> _......_. "--- ---•--.---,1--................................. <br /> .......................... -------•-------••-` .............. .......-,. ......................... :... <br /> ... . .... . . <br /> s �., <br /> ' (Draw e�iting and required addition on reverse side) :, ,, / <br /> I hereby Certify that I have pro this application and that the work will,be�on�n a ca dance with, Sar Jb 11 '. Ca, <br /> �`�teq Distract- 4"Ownbr or.licensi3d\agenis <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Loco ♦ 6 w <br /> signature certifies the following: <br /> , " 4 .- .yam <br /> "I eertify*that in the perform6nce of the work for which this permit is issued, I hall no��ernploy'any�p�ersar+ In such manner s <br /> to become subject to Workman s Compenso ion <br /> ya s o ' California.". <br /> y1 Aw <br /> Signed.............. :...- <br /> _.Owner � �i # ;a- � `,. °'�. <br /> .......... <br /> 4 . <br /> B. ........... . . .._..-......._.._......- Title -•--- <br /> y ; <br /> (If IN <br /> other than owner) <br /> F4 DEPA TMENT USE NLY <br /> APPLICATION ACCEPTED BY . r+''��... ... `� -- ---------------•----.......:.....__._DATE ...�4�� � '.._.....\..... <br /> �/ y <br /> DIVISION OF LAND NUMBER...---......... .... .. DATE...-- ..------... <br /> ........:..... :............. <br /> ADDITIONALCOMMENTS............................................•--•----•-•---•------•,..-...----------•--------•-•--•••-- <br /> ------------ ----------------------1-..------------------ <br /> . <br /> ......__.... <br /> ...--- ....... <br /> Date <br /> .} <br /> Final•Irispecnon by:...... <br /> ... 7 <br /> i EH 13 24 SAN JOAQUIN LOCAL-HEALTH DISTRICT refs zian Rev. aha oM <br />