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l FOR OFFICE USE: <br /> FOR OFFICE USE: �I APPLICATION FOR SANITATION PERMIT <br /> �S <br /> Permit No.---�7-`-�- <br /> -------------------------------------------"------ <br /> (Complete in Triplicate) <br /> I <br /> Date issued--�c0----�"-- <br /> This Permit Expires 1 Year From Date,Issued <br /> \ : <br /> Application is hereby made to:the San Joaquin Local Health District for a pb rdit to construct and install the work herein described. <br /> This application'is made in compliance with County Ordinance No. 549 ancl;'existing Rules and Regulations: <br /> CENSUS TRACT <br /> ` `` <br /> 108 ADDRESS./LOCA N -. <br /> --6H- _ 4 / -„ <br /> _ _.n ``LL <br /> # i Phone_T� <br /> Owner's Namfes- <br /> - _ _ r ----- ------------- - <br /> a� ?_-. City.. <br /> Address- = -- - ------ 6�� Zip <br /> p <br /> �. <br /> 3.------Phone._ �r-s-6s - -`- <br /> ` --- - License # <br /> Contractor's Name.- -_-- -;- <br /> F <br /> a ny <br /> Residence Apartment House.❑ Commercial ❑ }Trailer Court <br /> El <br /> Installation will: serve: I� .., <br /> . Ma{tel• i Other--- - <br /> -- <br /> __••_ _ -- _ + <br /> � Grinder,_.__-,Number of living units: _ -€ Number'of,bedrooms-.= Gprbage .Lot.SizePr,vat <br /> Public S stem and a - <br /> name_.-:------ - - .=--•------- ------�- -� ---.:------ �----- -- --�--„_------ <br /> 1;1 <br /> Water Supply: yst9 --- ----------- - <br /> Private <br /> PP Y <br /> _ Character of soil to a depth of 3 feet: Sand ❑ Silt❑ <br /> Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> - Fardpan El . Adobe Fill Material -----If yes, type-----. - -------- <br /> , ,- r <br /> r <br /> (Plot.plan,rst±ow.ing size of lot, location of'syste`m in relation�fa wells, buildings, etc.'must be placed o everse side.} t <br /> -� kY -,�-�^� 1 '.i� ` it permitted if ublic sewer is available�nrithin 200 feet,] <br /> NEW I�NSTA{LAT.ION: (No septic,utcink.•oiq seepage p' p P �. r <br /> ! tae.t ^ t _ ---Liquid Depth.-._7�------- <br /> ,� . .� .- - <br /> PACKAGE TREATMENT [ } SEP'-:TANK '+ '.. <br /> ze----------- ' : -- I S <br /> I``fes Material---� J `No. Compartments--=----� --- <br /> a Capacity-l.®(.cs+ = ._Type---f - e `”' -!C" ,'-�- <br /> Dist` �' Fou' <br /> ndaTiI, l0= -- - Prop, Line-ea--- <br /> ance to nearest: Well--.---.aft;-- <br /> "A No-of. Lines___ ... ----:.Length of ea line, _ .-1 � ' G <br /> ' Tota h.; <br /> LEACH,ING$LINE ------- -, <br /> • _ Len t -- <br /> Depth Filter Material--_------_- --------------------------- <br /> _ T pe Filter Material__- -; �, <br /> 'Distance to nearest. ' <br /> N <br /> st: Well_._-_�:�-'-------- -- ` --.Property Line---1 <br /> r r . <br /> y, o e <br /> r <br /> 't SEEPAGE PIT ,. Depth--- -7-=----Diameter_,- ----------- <br /> Rock Filled Y s'� <br /> • ,l 'Nurrlber_._1._ y -: � <br /> ... u <br /> � �* ! _ ;;t � -Rock SizeI Y i <br /> ter. Table:Depth---==-r--,-----. _ K <br /> a - Foundation <br /> Q Prop. Line._ i-- <br /> "'ff., <br /> . <br /> - Fund to l_ <br /> Distance'toaaeare's`tV�lelf--4-.--------f ---- <br /> . t-'"•«.,.�— --�.• yam-- i.�_..-..,� � '� � ] <br /> Date•_-.;k� '------------- <br /> - �.v <br /> REPAIR/ADQITION (Prev:-Sanitation Permits__:°--""""''----_-----=-�-- - , <br /> ---------- ------ <br /> i relents]---=-"--_---:---- ------------------- <br /> Septic4 t <br /> Dis osal Field (Specify Req -------------- = <br /> Tank Require <br /> ------------------- <br /> - <br /> ih-. .: : i -------- <br /> it________._____---- -------_._-------------g-------------------'-j­­ ----------'-- -----' <br /> (Draw e, istiri and required addition on r <br /> --------------------------------- .. everse side <br /> I hereby certify that'1 have-prepared 'this application-and that the work will be done in accordance with San Joaquin County <br /> lations of the San Joaquin Local Health District. Home owner or licensed agents <br /> Ordinances, State Laws; and Rules and Regu <br /> W 1. <br /> signature certifies the following: _ <br /> "I certify that in the perForrnancg of the work for which this permit I issued, I shall not employ any person in such manner as <br /> to become -subiect. to Wo'rkman's Compensation laws of California. <br /> r ` Own _ <br /> Signed----------------- - --`-------- ----=--- --.------ ------ <br /> Y <br /> ..--- .� r _ _-- __•-• _-• _ <br /> {yr Title 4 1 t <br /> BY---- -- <br /> ----- <br /> If"other than owrier) <br /> 'LFOR DEPARTMENT U5E',ONLY; <br /> r <br /> APPLICATION ACCEPTED, BY_:-___-- _ -- ---- - <br /> -:-------------- ------------- <br /> III -DATE.jA__ = <br /> 1 ----------- ----- DATE = <br /> DIVISION OF LAND NUMBER t <br /> W. � ------ <br /> ADDITIONAL COMMENTS ._--.-.- <br /> s -�l'? __ .:------''--------------------------- - ------------------ <br /> ------------- <br /> ------ - <br /> r- <br /> - --- <br /> -----'---------------- r- ---------------------- <br /> -------- <br /> ------------ --- <br /> ------------------ <br /> ! - �,`�_� <br /> t _ <br /> � � D -- ---ate. <br /> Final Inspection by:_-_ �-� - <br /> - <br /> F&5 1677 REV, 7/76 31 <br /> EH 13 24 i1 SAN JOAQUIN LOCAL HEALTH DISTRICT ` <br /> � k � <br />