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FOR OFFICE USE: _. FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> --------------------------------- ----:..::r--- Permit No...7-F".`5. . <br /> (Complete in Triplicate) a <br /> -.....: <br /> Date Issued-. .,�:�"�� <br /> .............................. This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to-the San Joaquin Local Health District for a permit to construct and.instali the work herein described. <br /> This ap lic�jt, ade in cpm et CountyOrdinance No. 549 and e�iisting Rules and Re ulatilo}s: <br /> "JlC . ' r <br /> /. <br /> A A DRESS/LOCATION----- - (2:S-0_.. PJ7`r -: ref" /" -'1 :- t=:.t" .`..CENSUS'T-RA-CT.r n ......--- <br /> Owner's Name.... . { i IR........ ...... -••` Phone. <br /> 1 <br /> Address-326 ..r . .. 1...1. 1 /'/"P . CitY _ .. Zip SLA <br /> j. <br /> .. ---- - ..-; License <br /> Contractor's Name........6a <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ i <br /> rotel ❑ ' Other------------ -------- - ------ ------ f <br /> sNumber of living units:........1-'`.-Number of bedrooms_.. ;f Garbage Grinder.A4ZAot Size----66 ..... - Q <br /> ,Water Supply: Public System and name-------------- --------------- ----------. ----..........------------------------------------------..---- ------------- Private <br /> JFri� <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ ij <br /> Hardpan Adobe❑ ' Fill Material.. ..,. ...lf yes,' type........:------------- <br /> 1 <br /> I <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.). N <br /> k <br /> NEW INSTAL;ATION: {No septic-lank or seepage pit permitted if Erublic2s,ewerfs available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [ , Size......, <br /> . .---.---- lquidepr <br /> Capacity.../ � Compartments. ... --. <br /> ? <br /> Distance to nearest: Well---..._..10.0- -- -------- ---------Foundation--.---...J0...-- . Pro Line_.,.. <br /> Len c .+Q Tata) Length ..P'I-r50-f---- - ------ <br /> LEACHING LINE [ ] No, of Lines ---3 Length of each IiDe th Filter Material.:..._�.�...."-------- ----------- ---- --- --- <br /> i � at h <br /> 'D' Box....l... _ Type Filter Material P1.... p <br /> Distance to nearest: WelL..�.� _.�. .._....Foundation---- �+rJ -------._.-Property Line..... --- <br /> SEEPAGE PIT [ ] Depth.__ ....Diameter-...s ..-._--------------- Rock Filled Yes fqA No <br /> s-r <br /> Water..Table Depth----.--- ........ - --------.Rock Size.....- ......� ---------------------- <br /> to nearest: Well... . ------------------ - Foundation. Line_../W--� --------Distance ( - I� <br /> REPAIR/ADDITION (Prev. Sanitation Permit#. ----------------- ----- Date----------------­ --- - -] I 'I <br /> Septic Tank (Specify Requireme,ilts)..- t a- - <br /> Disposal Field (Specify Requirements)----- -------- ----- - <br /> - <br /> --- --- ---------------­----- ....... . -.-.-•-•...._.r --------- ------- <br /> � t I: <br /> " 4 t .".- -..... ...._....... ITE <br /> __.-....-.."..........................".....-.-..-.......-------------....-.._"".........__..---------.---------_-.._.. .._.-..-.-....-........._------------- -.._....-- - - <br /> 3 \. <br /> (Draw existing and required add ,itidn on reverse side) I� <br /> I hereby certify that I have prepared this application and that the work will the done in accordance with San Joaquin County) <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin`Cccal Health District, Home owner or licensed agentsl� <br /> signature certifies the following: <br /> "I certify that in the performance of the work for which this permitais'issued, I shall not employ any person in such manner as,j <br /> to become subject to Workman's Compensation laws of Californid:" <br /> ] <br /> Signed--- r <br /> ---.-.-"-.-.-.-------- -- <br /> 0 0'. <br /> :-- ..... <br /> BY Titln - <br /> .----- <br /> (if <br /> other than owner) <br /> r F011 D PARTMENT USE OlI <br /> APPLICATION ACCEPTED BY------. ...... <br /> DATE ti -., <br /> ..---- <br /> DIVISION OF LAND NUMBER .. DATE. i <br /> ------ - ---- ' <br /> COMMENTS--- - -- . --------- <br /> ADDITIONAL .. ............. <br /> -- --- �. <br /> " .----- ....-------- -------- --- - --------- - ....._."..-..---....-- - ---- <br /> ---------------- <br /> f - t. _.f <br /> -----"----------- ------------•------- ..-: --- - " `:... :, /� �'j� <br /> Final Inspection b <br /> .-Date ......mit -�L- --1� ....... <br /> EH 13 24 SAN JO QUIN LOCAL HEALTH DISTRICT F85 21677 RFV. 7/7 1*, } <br /> X11, <br /> 7 i 7 <br />