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f �� <br /> FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> --------------------------------------------------------- <br /> (Complete in Triplicate) Permit No---ZF-,g34 <br /> -------------- ------------------------------------------ <br /> Date Issued--,fr__ .'� <br /> ---- ---------'-------------'-_. ------ ---------"._.. This Permit Expires 1 Year From Date Issued <br /> ��6OoBfS`1Ci45S'triJ.:;� _ ;2:Fc"r3",: Li{-,�.srnE"�► � � hoz-o&o -�,3 <br /> Application is hereby made to the Sari Jdaquin Local'Hedlth'District fora 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 /> E <br /> JOB ADDRESS/LOCATIO,N_, y__� 51�----d>' -- �a r /� 3 l <br /> --- -------------------- -- -------------CENSUS TRACT. <br /> Owner's Ndme !:�onli5e71 <br /> -------------------------- <br /> - ; <br /> } <br /> Phone <br /> 5�9 J"? v r/Y - - -- V�v' � G u G TrH c . <br /> Address. �J ------- --------------------- --- --- - City- y Zip = <br /> z. -- - -�-�.� A ;n - <br /> Contractor's Name ' lyN. h--U/!/ {�I Sfal� License #.�6G-�`9 6 S i'4121 1 <br /> / ------Phone------ <br /> Installation will.serve: R6side' nceX Apartment, House ❑ Commercial ❑ 'Trailer Court ❑ <br /> .. -...: 41. Motel ❑ Other- -- ---------------------------------------- <br /> Number <br /> -------------- ,. <br /> J _- Garbe a Grinde-r__.._____._Lot Size--_"- <br /> _ _ --------- --- --- -- <br /> ng <br /> Watebr Supply:f lvi Pubincts: Number of bedrooms! f =" g . '-------- ------- ----- -----=-------•----------------- <br /> System and name-_--.,-..----- : ----:� � 13 ` C ---- - .: . ; ' Private ❑ O <br /> = :- ----- <br /> Character of soil to a depth of 3 feet: $and ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam Q Clay Loam,g )ti <br /> Hardpan❑ Adobe ❑ Fill Material}------------If yes, type------- -----------1-- ------ <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 [ ] " t Size------------- _____Liquid Depth..__--__.----__-__---z_ N - <br /> Capacity_-- - d_°--:_ yp �'�� cl s! Go�t�c p Z ' <br /> T e.._.__-- Material----------------- -- --No. Com artments-------._._____ --------------:- Z� <br /> i .ire "X�0 ---------------- = - f _Prop. LineSr i <br /> LEACHING LINE; [ ]w Not of Lines- <br /> Well-_- Length of each line. Foundation- _Total Lengthro ---------------------------------------- <br /> ,a7,4 <br /> -=----------- ----- --- <br /> r,'L7Q7✓ )9e-4 D Box -_= Type Filter -_ Depth Filter Material,_---x-_---------------------- --- <br /> N <br /> i '• Distance to nearest: Well- -------------------------Foundation---_-------�- -_`-.---:.---Property Line-------- --`---:------------------ <br /> SEEPAGE PIT [ ] Depth____ .-._.____.Diameter._____...--__._"--Number----------------- --------t Rock Filled .Yes ❑ No ❑Uv <br /> r Water Table Depth---------------------------------------------=------ ---Rock Size)- --------------------------------------------- <br /> t <br /> [ .:_Distance to nearest: Well _ ---------- $ <br /> } - -_ Foundation Prop. Line. <br /> REPAIR/ADDITION (Prev. Sanitation Permit#--------------_-___________________�___.___...Date_.__.,.___.__.____ <br /> Septic-Tank (Specify Requirements[- ----- -------=----=-------------=------- ------------- ------ - _=--------------------------------------------------------------k <br /> Disposal Field (Specify Requirements)------ ----------------------- ---------------------------- ----- ----------------------------- '--------------------------m <br /> ---------------- `- -------------- --- ------------------------------------------------ --------------------- ---------------------------------------------:-------I ------------=------------------------- <br /> --------------------- ---------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have preparedSthis'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 thelfollowing: r <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in .such manner as <br /> to become subject- to Workman's Compensation lows...of California." _ ;v <br /> 9 T! . <br /> Signed---- ! N-/.1]_m/Y_ '� ���f� .owner <br /> --- a <br /> � � <br /> BY-F "r --------------------------------- ------ -----.-.Title----- --------------------------------------...-------------------------- <br /> h <br /> --- - ----------------- <br /> -(If othe . owner) 4... <br /> 1 1 , <br /> t R DE MENT LI;sE NLY: F <br /> APPLICATION ACCEPTED: BY__ <br /> --DATE.- '-. . 7 - <br /> DIVISION OF LAND NUMBER ------------- -- -- -- ----------------------------------------------------DATE--------------.----- :_______-- <br /> ADDITIONAL COMMENTS----------- -------=-------------.------------------------ = ----- <br /> 1 <br /> ------------------------------ <br /> ----------- ------------------------------------ --- -- ---- ---- - - ----- ------ ------------.:. --- --- <br /> ---- - <br /> Final Inspection•by:------ - ---------------------"--Date::---=_ . - ---- <br /> EH 13 241 F&5 21677�ItEV 7/76 3M <br /> AN JOAQUIN LOCAL HEALTH DISTRICT (`J(J��j <br />