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FOR OFFICE USE: . - APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> _ <br /> ............................................... (Complete in Triplicate) <br /> _ Date Issued <br /> .6-----I!�•••••� <br /> - .-..-... This Permit Expires I Year From Date Issued <br /> I and Install the work herein <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construc <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regularons: { <br /> CENSUS TRACT _..5.�.- ...L.. i <br /> 7. JOB ADDRESSACIC TIC)N. ..7-b.�.�-D....S .Cdt-jj-Qnl......-fR- ........ <br /> f <br /> Owner's Nome <br /> � ...... .. .. 1.7..rJ - ........... .. _...._ _. <br /> ,(j ..... .-.. .- Phone <br /> ¢ G7... �........C M�.W.tsc. <br /> Address ..Z.�...... U,.. ..cS...- ..... ./.Q-L✓...-.f.......- ._ CItY"---- - _........ <br /> Contractor Name..9� .... ...-...License /V... Phone "'o' ------'- ' <br /> _� .. ls......1-/q.._ �� Q..-_........-.. 1 <br /> ,a htstollation will serve: Residence C�ApartmenttHnHouse 0 Coognmercial ❑Trailer Cour ,0 i <br /> Motel Other...CJ.. /ac-- GRr�.9e <br /> Number of Irving units:..... ...... Number of bedrooms ............Garbage rinder ............ Lot Size ---•---- <br /> ,._ <br /> .....Private <br /> Water Supply: Public System and name .................................-....................._......._.......-.... <br /> Character of st.l to a depth of 3 feet: Sand❑ Silt❑ Cloy ❑ Peat❑ Sandy Loam$ Clay Loam 0 <br /> P ❑ ❑ W teriol -NQ if yes.type-'........:......:....r._I;O l j <br /> � <br /> Hardpan Adobe Fill Ma , , - <br /> 3 <br /> (Plot pion, showing size of lot, location of system :n relation to ells, 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,) <br /> PACKAGE TREATMENT [ ] <br /> SEPTIC TANK[ ] Size................................................ Liquid Depth ..........._..�..,..� ..-6% <br /> Cdty _ <br /> oaci ......- Type .................... Materiol. ................... No. Com rtmeMs - - N <br /> ..........:.. <br /> Distance to nearest: Well ....................................Foundation -...Prop. Lint..._.._.. ._.._. <br /> t Cs <br /> i _...... Total Len .....-•-- <br /> LEACHING LINE [ 1 No. of Lines ....................... length of.each line............................ <br /> '" ..Depth Filter Material <br /> _,.__� Do <br /> - 'D' Box -..... ..... Type Filter Material ................ . <br /> --f Distance to nearest: Well ........................ Foundation ....-.........-......... Property HLina .._..._...,..._._.- <br /> - <br /> ... Number Rock Filled-' Yes ❑ No I(_7 <br /> i SEEPAGE PIT Depth Diameter ............ ��-����-����-��--------- <br /> Water Table Depth Rock Size..... - . <br /> Distance to nearest: Well ........................................Foundation ......._........._ Prop. line <br /> .... ................. <br /> .. Date ....... 1 <br /> RPAIR/ADDITION(Prev. Sanitation PermitsP - -- -- - �'-"'-'-'-•'-""---•'-- - - <br /> Septic Tank (Specify Requirements) .. ...................... w'•' <br /> G/a( ......Pit... . 6 .. ... . . <br /> Disposal Fiel (Specify Requirements)_ � �� � ••�� ,X <br /> _ ............................_..._.....- ......_ , ..- ...- <br /> - - ....... ........ <br /> , <br /> e . [Draw itjristing bnd iequired bddiNonon reverse side) r <br /> y <br /> I hereby certify that 1 have prepared thio application and that the work will be dens In ate::dance with San Joaquin <br /> en. <br /> S County Ordinances, State Laws, and Rules and Regulatioaf of the San Joaquin Local Health Distrirt. Home owner or Iicen- <br /> 4 sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is Ifeaedr 1 shall net employ any person In such manner <br /> as to became sublet to War an's Compensation laws of California. <br /> Signed . _.. .. ..... ...._ ............. <br /> "`.......................... Owner - <br /> • _-_.....--._...-.... Title . ....... .................................................. <br /> By-...._ _.._. h <br /> � <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY LL <br /> APPLICATION ACCEPTED BY . ... .. a.. ............... DATE.---.��..-�.v.-'.(� -• <br /> iBUILDING PERMIT ISSUED _..._. . ..._... ...._........-----...--_---.------............. ...............................DATE. ..................._.. .............-.. <br /> ......_... ....._ __..................................... ................_............'_'-- "•---.......-.............._...,......._.... <br /> ADDITIONAL COMMENTS ... .... <br /> t <br /> ................... ..._.. .. -. <br /> i <br /> . ................. r ... -.. ..... _..// <br /> Dare _. <br /> .... _...-....._.... .... . ... �- --... <br /> Final Inspection.by:�.. - -- -- - -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E.H. 9 1=68 Rev.5M <br />