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a FOR OFFICE USE: a <br /> -FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit <br /> -------------- ------------------------------ ---------- (Complete in Triplicate) _ <br /> -------- Date Issued---'s-=42--3_-e?7 <br /> This Permit Ex ires 1 Yacq From Date Issued <br /> Application is hereby made to the San Joaquin Local ealth"Di�i for a permit to construct and install the work herein described. I <br /> This application is made in eompl_ance�w,itb.,County O.rd.inance-N.o.-549-and,existing-Rules_and_Regulations:-..�-.-�.--- 3 I <br /> . ,. .._ <br /> CENSUS TRACT- _- <br /> JOB ADDRESS/LOCATION.- ---- U._�J.���} <br /> Phone------- ------- --- ------------------ <br /> ---------------------- --Nam := -'-...T---- 52__1111.- -0.. I <br /> i�' <br /> City. -Cl 'Lt - Zip;----------------------------- <br /> Address <br /> j ► ---- ' <br /> t hone �7? <br /> Contractors Name-'- F--�✓-/J.,4%-� License #. .? f �J <br /> Installation will•,serve:•_- Residence, A artrrment House❑ Commercial Trailer Court <br /> p .7`"a� `` Motel Other- = ` <br /> 1 t <br /> _t- �, .Lofi�Size 4:J ------- -=--- ------- <br /> Number of liv.ing,units?��_._._-'----_-Number of bedrooms ___-.:,___Garbage Grinder.- __-_.-- <br /> lial <br /> ,4 i 1 Private in( <br /> ------------------------- - -- <br /> Water Supply: Public System-an name--_,__-__--___._-___,-; _--- ------------------------------------------- <br /> F <br /> - <br /> u - <br /> Character of soil to a depfih of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ sandy Loam Clay Loam ❑ <br /> _ _Hard•iJan ❑ Adobe'❑ Fill Mated 4 al------------lf Yes, type---------------------- -------- <br /> I {Plot plan, showing ize-of-lot,loeat+on of system_in rekatia_rr,L. wells, buildings,�etc. ,must be placed on reverse side.] <br /> ON )No septic tank op eepage~pit,-permitted if public sewer is available within 200 feet,] <br /> NEW INSTALLATi <br /> l i --------- ---------------No. Compartmentuid s <br /> Depth - <br /> ,� [_] SEPTIC TANK I ] ------------ P { <br /> ---------------- <br /> Size--------- --- -- - <br /> ----Mote-Tial--------- J <br /> i PACKAGE TREATMEN'T��CapacitY-------.--------------TYPe-------------- i- <br /> I � � <br /> i .: Distance to nearest: Well -- - - - -- ---- -- --Foundation.-- --_ ---. - -----Prop. Li ---_ -_ --- ---- - <br /> ne <br /> r ! "s 104� ------------- <br /> ------------- <br /> f,l -------- <br /> N-6775f-ti �� --Len th oeach Ursa- - ---- - --- Total �e gth <br /> LEACHING LINE , I' ]�� - g.. _F <br /> 0 <br /> 'D' Box Type FJlter Material ._ __. __-- - °Depth Filmer Material -____ _____ ------ <br /> ------- <br /> �} <br /> --- Pro ert lLine- <br /> L 0 �� 1.Uil i--- FQrndat�on P <br /> Ilp <br /> . .. <br /> 1 PIT [ Distance to nearest: Well _._ <br /> I -Diameter.-_-. r' Rock Fill Ye ❑ No ❑ <br /> 1. � Depth ---'- - - -- Number -------- -----'------ -------- s <br /> • ed s <br /> 1l p 1 [a �� <br /> :a. Rock Size-------------------------- <br /> ----- <br /> Water Table Depth.--- <br /> .�j <br /> - <br /> -------------- ---- Foundation Prop. Line. _ <br /> Distance to nearest:�Well.___.=_:..�1.____- � <br /> `=_:�=�'•.�. � � --.Dat <br /> REPAIR/ADDITION (Prev. Sanitation Permit#__-------------- :- p <br /> I -- <br /> Septic Tank (Specify, Requirements)------------- - --------- ------------------------------------------- F Ck` <br /> t Disposal Field (Speck ,,Requirementsl-__._.._�---- - - -•-- -------s� -""- <br /> t - --- _- - .- ® _,. ---------- --- - ------ <br /> .� s - <br /> - + <br /> ------------- <br /> --------------------- <br /> _---`__- I .^a'!wr•rn+�+rtN --- -------------- -----:--- 4 <br /> ------ ------ <br /> -t -�; --------------------------- <br /> --------------------- <br /> - <br /> 1 ' �(pra sti g,and required addition on reverse side) <br /> �- ��-� -- .' that the work will bh done in accordance with SanJoaquin County <br /> I hereby certify that"hhave prepar�Fs.fsation and <br /> �� <br /> Ordinances, State I ci;k and�R lesdnd! u tions of the San Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies thefoll'owior. E <br /> a <br /> "I certifythat in the 1 erffor ' nce olF the work fir whichlthis permit is issued, I shall, not employ any person in such manner as <br /> to become subject f to �in 'somens`n io . laws of Ca4iforni�Signed-------- - s ------- <br /> - <br /> ' �.E { ------------ <br /> -Tite <br /> i <br /> B -- <br /> (If otlfSer tha R o ner) <br /> i <br /> j. ` +' R'DEP RTMENT USE ONLY <br /> DATE <br /> ACCEPT;EDBY ,_-___ -- ___ .-- . _ <br /> .►fir.[' __N------------------------------- <br /> ---------- <br /> APPLICATION -------- fr DATE_. , <br /> pIViSION OLAND"i�VL11'+ ER --R- - ►-- - . - - ---.- .-% r <br /> Gam- -------------- <br /> F ADDITION L COMMENTS!.-Uzf'�- <br /> J s <br /> v --- ---- ------------ <br /> Q_ `� --- --- - --- — <br /> . <br /> ----- --- - -------------- ------ <br /> ---------------------------------------- <br /> Date <br /> Final Inspection by:.__-.__. _--- -- ------ <br /> - ------------------------------------------ -------- <br /> f85 21677 REV. 7/7h 3M <br /> EH 13 44 SAN JOAQUIN LOCAL HEALTH DISTRICT <br />