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FOR OFFICE USE: <br /> F <br /> w <br /> APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: <br /> ^� <br /> "-"\ (Complete in Triplicate) Permit No...._7 `._ 7 <br /> ----------- ---------------------- ----- -- This Permit Expires 1 Year From Date Issued Date Issued_.--_c�_7"7 l <br /> i <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This appiication.is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/ - _��` ; t ' <br /> �--� ----- --- <br /> Owner's Name -r.-_✓V..- F - TRACT---------- <br /> -------------- <br /> _ , <br /> - <br /> Address..�dQ_r� � _ � <br /> -- - .. Zi <br /> Contractor's Name ' e <br /> s ,C <br /> `License #--- ----Phone_ la <br /> Installation will serve: Residence [!Apartment House.❑ Commercial ❑ Trailer Court ❑ ' <br /> r.. // Motel ' Other... - <br /> `= ----------------------- = = <br /> Number of living units:..__):__-------Number of bedrooms_._.-q7�_Garbdge Grinder_:--._..?:Lat Size_.-�" <br /> Water Supply: Public System and name i -- <br /> _. Y ----- --------- ---------------Private ` U 1 <br /> Character of soil to a depth of 3 feet: Sand ❑ "Silt❑ Clay ❑ Peat Sand Loam I <br /> Hardpan v- ❑ Clay Loam ❑ <br /> t P ❑ + Adobe ail"1'Material- - :---- If Yes, type ----------- ' <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc,must be placed on reverse side.) <br /> NEW INSTALLATION-"" (No 7septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ]'--ASEPTIC TANK" [ _ Size..__ _�a�x �� - ��. <br /> 1 --------- <br /> _ Liquid Depth ------ 4 <br /> r <br /> -.___ <br /> ..Material.( --- No: Com Compartments--- --- --------_- <br /> 1 bistance:to.nearest: Well _ ^dTlQi <br /> ----------- <br /> € # f ; F undatI .:---------------------CProp. Line..P ----- t <br /> 0 <br /> LEACHING LINE [y' No .of.Linl- --- Len th of each li.ns_..: d D <br /> .. g - <br /> l rot <br /> ! D s ante to Weare a Filter Material s/t d�Y Depth-Filter Material.......�s�_- <br /> /44 <br /> ------------------- <br /> --- Y <br /> -- <br /> e�`/ . <br /> st: Well _ -Foundation_-._ D _. --.Pro ert Line.._- l <br /> SEEPAGE PIT <br /> .. . <br /> ['� Depth_ . Diameter r 'G - -Number y <br /> s - -- - Yes Zj—N <br /> o Ej <br /> Water Fable Depth.. ^ l5 <br /> - = � Rock Filled <br /> - RockS`iz �.. <br /> e- <br /> I Distance'to nearest:Welles_ _ ._Foundation__: _-_ <br /> REPAIR i ' " <br /> ` P <br /> rop "Line-- -5= r-- <br /> ----- <br /> /ADDITION (Prev, Sanitation Permit#a_ _±- - -_ } " t <br /> Da e <br /> Septic Tank(Specify Requirements)-----_------i_--__J-------_:. <br /> ------------------------------------ -- --- - <br /> Disposal Field(Specify Requirements)-_- -------- -------------- <br /> ------------------------------ <br /> ----------------------------- ------ <br /> 1. <br /> I . . = = . :_ - - . . ----- --- -- -. ---- --- = --------- -- ----- -- <br /> -----=--- ---- <br /> -= - -----------=-----------'------=---------------- ----------'_----- --------- <br /> # r v. (Draw existing and required addition o'n""reverse side} \ <br /> I hereby certify that I have-prepared this,application and that the -work will be -done=in•-accordance-with•-San-=Joaquin County <br /> Ordinances, State Laws; and, Rules :and Regulations of the San Joaquin Local Health District, Home owner or licensed agents <br /> signature certifies the following:. [ _ <br /> "I certify that-in the performance of the for Which'thii' -permit is issued,'l shall not employ an ' <br /> to become. ect to.Wo .man . Com errsution:,laws of ,California.',L person a anne s <br /> p <br /> Signed <br /> J� <br /> :jrk�s ------ ne<y e. <br /> � F <br /> i <br /> - --- -- Ow s m rka <br /> - ...,.a <br /> BY-1-------------, -,T- <br /> 1 �.�'` r ----- ----- <br /> (/ a -- <br /> itl <br /> ...-. a. p i._ t _ .. _ .- <br /> (If other than owner) _ <br /> a a <br /> ;,► FOR"DEPARTMENT USE ONLY y.. .. . <br /> APPLICATION ACCEPTED BY--. --__Gam' _ <br /> - '�`' - TE ]' ZJ <br /> DIVISION OF LAND NUMBER------ -------- ----�---- ---- - -- :----- --- -- -- --------- ------ ---------- <br /> AD- <br /> ------- -� <br /> : . DATE r <br /> [ ------------ - <br /> ADDITIONAL COMMENTS-----=- ------ - �------ �- ------- ------:--- �----. # <br /> I -- ------ ---- - <br />-----y----- ----- - ---=------------------ - - <br /> ._....._. ._ - �� _. - ... - - ------------------------ --- ---------------------------------------- <br /> R <br /> �_ .. .- ..-_. •-`---------------------------- - - <br /> Final ln ---------- ---------- -- - ` ------------------- ---------- <br /> spection b •a ---------- ------------------------------- ------ - ------------------- d <br /> r j <br /> FH 13 2A --'"__:Date- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21,577 REV. 7176 3M <br />