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FOR OFFICE USE: <br /> FOR'OFFICE USE: APPILICATiON FOR SANITATION PERMIT permit <br /> .....................I------------­------ ........ (Complete in Triplicate) <br /> Dote issued. <br /> ......................... ................. This Permit Expires 1 Year From Date Issued <br /> ........ ................................... ...... Joaquin Local Health D. istrict for a permit to const I ruct and install the work herein described. <br /> Application is hereby made to the Son 549 and existing Rules and Regulations: <br /> jcc�p2n is made in complicincwh county Ordinance No. - . . - -- I <br /> This appli ---------------- <br /> S/7' 27'. ..............................................CENSUS TRACT...-- <br /> ................. <br /> 17- 'r- Phone-------------------------------------- <br /> JOB ADDRESS/LOCATION---rZ j4p <br /> - ---- ----------- ....... --- <br /> V. .......... ........ ..... _.-Y---------- ;W15*........ - ............................ <br /> Owner's ..............City.._...... ...... ------ ....Zip.. <br /> � <br /> .................. <br /> Address.................. ........Phone <br /> License <br /> Contractors Name..__..... ...... House.Q Commercial 2,'.'�Trailer Court <br /> Residence❑F1 Apartment Hou <br /> InstallatiOn'will serve-. Motel f7 Other..........*._�..................m.............. <br /> ................... ........ <br /> L.0.....Number of bedrooms------......Garbage Grinder...!P LO;.Size--- ---------------- <br /> of living units:_- ....................Private <br /> Number ................... ....... <br /> ......... . <br /> .................... <br /> Water Supply- Public System'and name-_-_----:-7-------------------7----------r ❑ <br /> - <br /> G Cloy 7 Peat F71 Sandy Loam ❑ Clay Loam <br /> Character of soil to a depth of 3 feet. Sand 0 <br /> Hardpan Fill )M <br /> Adobe Fp_r- I ateric.l.. ......If yes,type..-,I----------------------------- <br /> of system in relation to wells, buildings,.etc. must be placed on reverse side.) <br /> (plot plan, showing sizeoflot, location is available within 200 feet,) <br /> ge it permitted if public sewer <br /> ----------- <br /> NEW INSTALLATION: '![N6­sep!ic tank.or seepage P P Mitt Depth.. .-------------- <br /> 7 - ...........Liquid <br /> -SEPTIC TANK Size...._...-........................... --- <br /> PACKAGE TREATMENT .1 ------- :------------------------ <br /> 0, Compartments. <br /> TypeA <br /> Capacity..../ .. ..---•••. <br /> Prop. Line......?-_)i----------- <br /> -2-4-:6 'FoUnclation...-eP <br /> ...... ......... --------- <br /> DistanceJO nearest-. Well -------- <br /> Total Length.............I ------••-:. <br /> t.EACHING LINE. No. of,Lines..... .77% ...... ...:,.!Length of each .......... r........ .......... -----_-------- <br /> • epth Filter Materia <br /> `D' Box-...1'.-..Type Filter Material-./ ...... ------- ..W <br /> .............Property Line <br /> -0 ..... <br /> ----Foundation------1� <br /> Distance to nearest: Well.. .2e� Yes [] No <br /> Rock Filled <br /> ❑ <br /> ............Number--------------- ----------- _- <br /> SEEPAGE PIT pepth--o4M--•-•-------Diameter-------- <br /> '..' : I..................-Rock Size------------------------------------------------- <br /> Water Table'Depth-----------*..................... <br /> Prop, Line-------------• ------------ <br /> Distanc.e to nearest.Well..._.._.:_...___..._.-....... .............Foundation _------------------- <br /> ---------- <br /> Date-------------- -------------------- <br /> REPAIR/ADDITION (Prev.,Sanitation Permit#-------------------------!-------- d............*.............................................................. <br /> -Req�irementsl...... .......74...I.............. ...... .......... ... ----------- <br /> .............. <br /> Septic Tank (Specify �tT�...;................. --------------------------------I...... <br /> 1 t5)._-­­­7-------------------------------------- --------- - <br /> Disposal Field (Specify Requiremen ...... ...... .....­*-- ------ <br /> I .r„ f4 ..................................................... <br /> .......... ------- <br /> ------------------- ----------­-------­----- <br /> .......... .......­........ <br /> .......... .................. <br /> . ..................................... <br /> ...............................................................7. - '" n reverse side) <br /> (Draw existing and required addition 0 accordance with San Joaquin County <br /> tion and that the work will be,done in <br /> licensed agents <br /> I hereby certify that I have prepared this app <br /> licc Home owner or <br /> Ordinances,- State Laws, and Rulles'and Regulations of the Son Joaquin Local Health District. <br /> the following: % play any person in such manner as <br /> signature certifies for which ,this permit is issued, I shall not Om <br /> "I certifyI 'that in the performance of the work. -_ alifornia." <br /> to become sub' W kman I s ComPe" on laws of C <br /> .............Her ...... <br /> . ............. <br /> lb W* <br /> Signed---------- - ............... <br /> Title__-- -------- <br /> Byl............................. ...................... ------....`-• <br /> ................... .......... .. <br /> (if other than.bwner) <br /> ONLY' <br /> ft DEBAIUMENT U-E <br /> D <br /> ................. <br /> . .... ... .... .. . . <br /> APPLICATION ACCEPTED BY...... ....................................DATE:...... ------------------------------- <br /> .. .... -------------- <br /> DIVISION OF LAND NUMBER:......:........•---...-----............... .................... <br /> ........................................................ <br /> ------------­-- ------­----- ....... ................................ <br /> ADDITIONAL COMMENTS...................•----•-•------------ ......I --•-----•--:...:.---....----•--..._...---• <br /> ----------I...___-_---------- <br /> ------------------- ................................. ......................... ........i............................. .......... ................... <br /> 5' i.................................. .................. ------!................................. ...................................... . .....................7..../- - .................... <br /> ............................ ------------------ ................... <br /> --- --..........•-----•---•• <br /> - --................................... ......................... ......D --------- <br /> 4_1 w .7/76 31V <br /> - ------ F&S 2= <br /> Final Inspection by:------------ :Iap�_ ______SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> SH 13 24 <br />