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FOR OFFICE USE: )I;f��� Z u yl`I�-Q✓ _ FOR OFFICE USE: <br /> q� ' APPLICATION FOR SANITATION PERMIT <br /> . ---.... ... . (Complete in Triplicate) Permit No.T._.____4(:5.1 <br /> •-••--••------------------ --- -•---------- c� <br /> Jt, "'Y- Date Issued_C.. ..':�- <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.install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION...A.dT_ -N .Y--_S ,foA C 6 ..............CENSUS TRACT---------.-------- ------_-- - <br /> --------- <br /> Owner's Name.... ..-fQ.�...... ... ........ .............Phone--- -----•--•- <br /> Address...- � - - --- City ( � Y -- - Zi <br /> Contractor's Name. . vv �_�lY __License #-.�o6..s g6. Phones 'i3 '/F1- 1 <br /> Installation will serve: Residence)] Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other-- - - ------------_ .------------------•-- <br /> Number of living units:-_...,, .-..._.Number of bedrooms.... ----_ Garbage Grinder............Lot Size----- ................ <br /> Water Supply: Public System and name------- -----._.,-5:.✓' C' .-.-__--.------Private ❑ <br /> - - <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam' Clay Loam <br /> Hardpan ❑ Adobe ❑ Fill 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 septic tank or seepage pit permitted if public sewer is available within 200 feet,) \ <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size............/i.DD <br /> -- ----Liquid Depth.-..���_._..-....... <br /> Capacity../20d Type Are G.Wir, Material.Gm/4�...........No. Compartments-.-A........... ............ . _ <br /> Distance to nearest: Well.Joahll4 ..GGI$.f�1�!-....:Foundation....l� ..._.._. ...Prop. Line... .s.�� Q` <br /> f <br /> LEACHING LINE [ ] No. of Lines - .... Length of each line...-`-----------------------Total Length � <br /> Te> Bed 'D' Box----I-._...Type Filter Material-_BOG _-...Depth Filter Material.. <br /> to nearest: Wel/LQlfti.-_at F�..b6undation--- Property Line... ..-__ ------ ........... <br /> SEEPAGE PIT [ ] Depth---------- -----Diameter-----------------_.Number-............-------------------- <br /> Rock Filled Yes ❑ No❑ <br /> Water Table Depth------------------- ------------- ..................Rock Size.--------- _------- ------ _O <br /> Distance to nearest: Well.-...-_--..-_---__..._..................Foundation._....--___----- Prop. Line_-----..........._..__-0 <br /> O <br /> REPAIR/ADDITION (Prev. Sanitation Permit#.._._._................_--__... .. Date.............----------.-.--_---------------- <br /> Septic <br /> - -----Septic Tank (Specify Requirements).-...- . ....................... . -- . - --------------:..•_--... __-------- --------------- ----- ----•-- <br /> Disposal Field (Specify Requirements)-__.. :.........----- ........................................•-•-•---......_ ---­--------------__------- -----------•-• <br /> --- ----- <br /> (Draw existing and required addition on 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 work for which this permit is issued, 1 shall not employ any person in such manner as <br /> to become subject to Workman's Compensation laws of California." <br /> DN.. .$04' Owner <br /> Signed - _ - ----------------------- ---------- <br /> By.. - - -----------------------------_-......:.:Title... - - <br /> (If, er than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _ ... -------•----. ----..-DATE - <br /> DIVISION OF LAND NUMBER.- - - --- DATE- -- ................ ../...... <br /> f <br /> ADD�I 10 AL CpMMENT/S.� ��/ .l._..h� .... ..- e°.:. fIr .i��..- ftia- -- Ie .__!y...�y�`. <br /> LS_ v. f�i�!. <br /> ------------------------------------------------------ <br /> ................................................-.. - ------------ ----------- <br /> ------------------------- ---••--------------•- ---- . --. ----- - ------ --•------------••--_... . . <br /> FinalInspection by:- -- - ---- ---------- - --- _---- ---------------------------------------------------.-Date-------•----------- -----•----- ----- <br /> EH 13 24 SAN JOAOUIN LOCAL HEALTH DISTRICT F&s 21677 REV. 7/76 3M <br />