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FOR OFFICE USE:- - - _- FOR OFFICE USE: <br /> L APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No.7.9..7577 <br /> ---- -.._.................. ------- <br /> Date Issued_-..?.c <br /> ................ .................------------_-._..._ This Permit Expires 1 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 described. <br /> This application is made in compliance with Count Ordinances No.o. 549 and existing Rules and Regulations: � ) ,y� <br /> JOB ADDRESS/LOCATION- ---- 57-- -------------"--:�-----------------.._........_----------------CENSUS TRACT.4l`Ll'{/7. <br /> kl <br /> Owner's Name.... - -- - d'�2Ls<-------------------- -------- ---- -------.......- ------ - Phone---.3, _�.f--'----- <br /> Address <br /> �r -- <br /> 3. <br /> Contractor's Name- ------------------------Ci --------b -- ZiP � <br /> - - -.-License #_o�Q�7�ZL - Phone.. 4� .1 <br /> f-J/--_ <br /> Installation U <br /> --- <br /> ---- <br /> will serve:- j-f esidence [/� Apartment House❑ Commercial ❑ Trailer Court ❑ <br /> ;4.. Motel ❑ Other..------------------------- ----------------- <br /> Number of living units:-----..._-Number of bedrooms----3...Garbage Grinder-.___.__Lot Size_....l�4-v'-- <br /> Water Supply: Public System and name------------..._---------__------------------------- -_ _......__ ---.-. -----_. ____.---------------------------Private <br /> Character of soil to a depth of 3 feet: Sand El Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ <br /> Hardpan ❑ p ook e,❑ Fill Materiel-.-----------I'f yes,type-----_-------------- -- <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-perrrritted if public sewer is available ithin 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK ]s,)/ s Sizi_.SA_571' 7� Liquid Depth__'s��x--.__._ <br /> Capacity.t�j - Type � i_Material.--- --(nA1d_,__. .No. Compartments --- <br /> r y r <br /> --' "foundation.__ .. _._ ------ Prop. Line--V--l-..--.---. . <br /> Distance to nearest: Well. �- .....:... _ _ -- -. <br /> LEACHING LINE ['7 No. of Lines _ Z Length of each line --- S._____---Total Length__l_ d_---_._.__._._____ <br /> ---------------- <br /> /!V. Type Filter Mgterial—/!l �'��.-Depth Filter Material_._Z_�...__._ re <br /> 'D' Box__/_!V. T rr�� - //-ee- - ------ <br /> Distanceto9egrest: WO _: (J`—.._�...____Foundation /5.�_._.__....Property Line__[.T.b./.._..._.-._.___. <br /> 11Ia� <br /> E'1 Depth it__... DwAaefer {T.' Number -I--- _._ Rock Filled Yeses No ❑ <br /> Water Table Depth,. _---- _Rock Size__ �p X-f <br /> -------- --- - <br /> Distance to nearest: Well 'Z _ __ _-Foundation---- `;1------- <br /> Prop. Line _l <br /> REPAIR/ADDITION (Prev. Sanitation Permit# _Date _ ------------------------------- <br /> Septic <br /> _-- __-.Septic Tank (Specify Requirements)--------....-------------------------------------------------- ----------------------------------------- ------------------------------------ <br /> Disposal Field (Specify Requirements)------------- -----------------------------.-------------------------------. <br /> -------------- <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 County <br /> Ordinances, 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, 1 shall not employ any person in such manner as <br /> to become sub[ o orkmann''s//C7amppeensation laws of California." <br /> Signed------ - ..... ._ 'lJ `V --------- -- --------- - ------Ownexr /fes <br /> By � .... ......Title <br /> - — <br /> (If other than owner) <br /> �o POR D ARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------�' - --- - ------- - ------------------------------------ -- ----DATE. Z 9 <br /> - --------------------- <br /> DIVISION OF LAND NUMBER------------------------------- --- -----------__-------------------------------- ---------.-DATE.--- --- - ----- ------------- --.._- <br /> ADDITIONAL COMMENTS-------------------------------------- -- - - ----------------------------------------------------------------------------------- - . __ - ------ <br /> ------------------------------------ --------- --------------------- ----------------------------------------------------------------------------- ----------------------- - --------- --------- <br /> .---- -- - - ----- -------------­- ---------- ------------------------------------ ------------------- <br /> --.._... .. _.._. -- -------------------------------------------------------------- <br /> - - - --. - <br /> Final Inspection by. -----------.0 - -- _ ----- -- -Date - <br /> Err 13 24 A N JOAQUIN LOCAL HEALTH DISTRICT F85 9611 REV.7176 3M <br />