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r <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT qQv-/ <br /> Permit No. ..�1 dam" <br /> - - - (Complete in Triplicate) <br /> ........ ....... ..... .__._. . Date issued .. <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 <br /> described. This acplicaticn is made in compliance with County Ordinance No. 54�0yannd/exiistiting Rules and Repulotions: <br /> �d.�� �/ 7`� y:1! yy .J0`c'Zt;NSUS TRACT .�>..` l ... <br /> O . GL <br /> JOB ADDRESS/LOCATION A r - ^+ v <br /> ..Phone <br /> Owner's Name <br /> ....Cr -J��C.fr. ... .. ...... .... .. <br /> Cortractor's Name - Phone <br /> License #G'-� <br /> Instmletion will serve: Residence ,'Apartment House❑ Commercial ❑Trailer Court a <br /> Motel ❑Other . .. qq_... . . .. <br /> -al Garbage Grinder l' . Lot Size ./4?.�? X..L.3... ....... <br /> Number of living units,_..�. Number of bed ams .... 3 <br /> Water Supply: Public >ystem and name ....... ._......................_. - <br /> .. GJ.2..C.4' .. . ............ ......... ..Prware. <br /> Ctara•ter of soil w a depth c'3 feet: Sand❑ Set C1 Cloy [-] Feet❑ Sandy Loom F_1 Clay Loam C1 <br /> Hardpan❑ A'iobe fill Material ._ __ .If yes,type. <br /> ......................... <br /> IPior plan, shouting 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 permitted if public sewer is available within 200 feet,) 0 <br /> _....__. .. ._. Liquid Depth ....... .................. <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [ ]r y t ,S 71 No. Compartments <br /> .,. ...................... O <br /> Di Pacify . ..est:. Type . . Pro Une ...................... <br /> Distance to neoresC,Weh _.. ..Foundation P <br /> or each line. -/ c� Total length ..41. . - <br /> LFo�.HING LINE �' ',Io. of Line' ���"� � � � � �. <br /> / ,r ..................... <br /> fY/1;.'..De th Filter Materiel . l. <br /> 'D' Box . . Type Filfe- Marenal JL P ���. <br /> L° dtion <br /> _ Founa .�� .. Propiriy Line . .�--.L�� ....._..... <br /> Distance to nearest: Well .. . $ - . Rock Filled Yes Imo, No ❑ <br /> SEEPAGE PIT o- .,S Diameter >_.'T .. Numl <br /> (�� Depth P i <br /> Water Table Depth � ..........Rock Size a7 <br /> Distance to nearest: Well Fo-"idarion r� <br /> Prop. Llne ....... . . .i.. <br /> .--... <br /> REPAIR/ADDITION(Prev. Sanitation Permit ....._. <br /> .... .. ................ . . <br /> . ... Dara ......_. _... .._.._...__.1 \Q <br /> Septic Tank (Specify Requirements) t- ....... / le�J'�' I� /G'�r�. ..._ _.. <br /> Disposal Field (Specify Requirements) / c�r� / G�T� <br /> Bfi.✓c,_ sy_siy T <br /> ( _ <br /> (Draw exisfing and,d required addition :n reverse side( <br /> I hereby certify that I have prepared this apPlicolion and that the work will be done fn accordance with San Joaquin <br /> county Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Memo owner or Me"- <br /> sed agents signature certifies the following: 1 shad not employ any person in such manner <br /> "I certify that in the performance of rhe work for which this permit is issued, <br /> oto became subject to to Workmen's <br /> m� atioo laws fCohfornl°Owner Nner <br /> Signed .Z_ Title le <br /> BY le .—c_r'— <br /> (if <br /> • <br /> (if �>a..il>:•'sit. cs-r1 <br /> _... .. ..... <br /> other than owner) <br /> FOR DEPARTMENT USE OWY <br /> mss_ <br /> DATE _ ...... ...._... <br /> AcPLICATIONG ACCEPTED BY DPSE <br /> BUILDINPERMIT iSSUED <br /> ADDITIONAL COMMENTS - - <br /> _ Dote <br /> Final Inspection by: . _ .. . . <br /> SAN iOAOUIN LOCAL HEALTH DISTRICT <br /> E. I., 9 1 '6R Rev. 5M <br />