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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br />--------------- ------------------`------- -------------- (Complete in Triplicate) <br /> r x <br />---------=----------------------------- -------=----•---ti's, ? ' i' Date Issued <br /> f'_,This,Permit Expires 1 Year Prom Date Issued <br /> Application is hereby made to the San Joaquin Local Health pistrict for a per to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance �No. 549 and existing Rules and Regulations: <br /> ENSUS TRACT -------------------------- <br /> JOB ADDRESS/LOCA ION - - -- <br /> � Ofv2�r�a.S' `-'-------- ----- •-Phone.._ ��� <br /> Owner's Name - <br /> rY1 tq I <br /> e - ------- <br /> 7C <br /> Address _ " <br /> --*-------- --�.. -------- --- ----------- ---- City` <br /> Contractor's+Nam'e"� C� -----------------------------E --.License-# A j Phone ------------------------------ <br /> S i ' <br /> Installation will serve: Residence ❑Apa ment House,❑ Commercial,❑Trailer Court Y!Ej i <br /> p - 4.rnj - <br /> j Motel: Other ._>__�_ <br /> Number of living units:__.,__--- Number of bedrooms ______Garbage Grinder --- ----- Lot Size "---------------- ------------------- - <br /> .. ---- -Private <br /> Water Supply: Public System and name -_________ ; - <br /> grCs3he r" . Sand Loam-_ —C1a Loam <br /> ;,�-pea of,soil.,to_a,depth_of 3 feet: .Sand-®��Si1t'QGlay' ❑ Y' ❑ y•. <br /> Hardpan E] Adobe E] Fill Material -.,_e----___ - yes,type ---------------------------- <br /> Plot plan, showing size of lot, location of system in relation to wells, buildings,,etc. must be placed an reverse side.) <br /> p Ze - i p ., sewer is within 200 feet,) �Nt <br /> NEW INSTALLATION: (No septic tank.or seepage-pi t ermined if u sew <br /> p [_y�/ <br /> PACKAGE TREATMENT [ ] SEPTIC TANK' `Si '" / -1. `---- ----------- Liquid 'Depth ---------------------.----- <br /> Capacity _/ -------- Type - ' _ _ Materia) No. Compartments ----j:•------•------- . <br /> Distance to nearest: Well ------------------------------------Foun afiio�n ---------------- ----- Prop. Line ---__---- ---•--�-•-- <br /> LEACHING LINE 1 No of Lines _--13--------------- Length of each line___-. ___/�---- Total Length ,_____5P.--------- -- ' <br /> [ V-Box Y"----- Type Filter Material 10 <br /> �-_�C------Depth Filter Material ______fin 22 ° -_-------•-----•----- <br /> -. ,r t Foundation __-: Property Line __ � �------- <br /> Distance to nearest: We ___��-_---------- ------------ p ty <br /> r ._ <br /> SEEPAGE PIT [ ] Depth —;- ..Diameter ----------------- Number Number -----Rock Filled' Yes ❑ N6-10 <br /> _ <br /> __. . Water Table Depth ---------- -------------------- --------Rock <br /> -_ _� .�.– _-- <br /> Distance to near'_est. Wel! ---------------------------- -----------Foundation ----- Prop. Line <br /> � date� ------------------ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------ '% . � <br /> ----- -------------- <br /> Septic Tank {Specify Requirements) --- ------ <br /> -• <br /> Disposal Field (Specify Requirements): ----- ------------------•-----•----------- ---------- - ------------- ---------- <br /> ------------------------------ -- --------------- <br /> r <br /> ` <br /> ___________. ----- ------------------------ <br /> ___________________________ .� <br /> ' s (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 <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or iicen- <br /> sed agents signature certifies the following:. _ __ =, - <br /> "I certify that the performance of the work_for which this,permit'is`issuetl;11"shall not employ any person in such manner <br /> as to becom -s lett-to Worlim n's C nsation laws of California." <br /> F----. Ower � w� <br /> Signed __. ' r� <br /> t ;title -------- --- --- <br /> BY ---- - ---- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY p� <br /> i APPLICATION,ACCEPT ED BY ---- ----- ---------- - ------------ ----- <br /> -------------------------------------------------- DATE __[]- .Lf- . Z –----------------- <br /> -- - <br /> BUILDING PERMIT ISSUED - ------ ° ---------- --- - ------- ---- - - DATE ----------------- ---------------- <br /> - --- <br /> ADDITIONAL COMMENTS - --- _- - --- -- ---�-- - <br /> ---------- <br /> --------- --------------- ---------------------------- <br /> --------- --------------- ------------------------------------- - - - <br /> `- ---_- <br /> ------------------------------------------------------------- - - --- <br /> '--- <br /> -------------------------------------- <br /> i ( nal !ns ection b Date y�. <br /> l `' � � f N JOAQUIN LOCAL H A ISTR T �t <br /> E. H.'9 1 <br />