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FOR OFFICE USE: �Z� FOR OFFICE USE: <br /> q APPLICATION FOR SANITATION PERMIT <br /> ---..............-.......-_ ........... <br /> (Complete in Triplicate) Permit No....--3:y. <br /> 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 E_-P .l332...5 _-_C�47 �l1�d_ l E ....64,44 .--CENSUS TRACT..---..... <br /> Owner's Name._.- 1 1V ------ 5 Oit/_..------... ----------------- -- ---------- --Phone 83S'- SA 6.8 <br /> Address.......340 - f r1 /1 55© P�--------._---- ---- --------- ----City--- i`PF3G/ .-------_----------Zip <br /> `....................... ...... <br /> Contractor's Name ... IISI-� J--5.04 a5..----- .------------ ---- -- --------License #.(;Z1_ .:_ z" ._Phone_..7`� _P ��p . <br /> Installation will serve: Residence`s Apartment House ❑ Commercial E] Trailer Court E]Motel E) Other....._- ----- ................ <br /> Number of living units:..._..�..__..-Number of bedrooms....Z _ Garbage Grinder........._Lot Size--.....SO �/O© .. <br /> Water Supply: Public System and name___ O/h lr./�J/T/.- . .�-Sc._----------------_--- ................------...............Private 03 <br /> r •' <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ ClayX Peat❑ Sandy Loam E] Clay Loam ❑ W <br /> Hardpan E] Adobe E] Fill Materia . _._ _..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 ._ .._.._.._-..........--------------------------------Liquid Depth..........-....... <br /> ....-.-- <br /> Capacity . -- . . _---Type.............. ._.....Material.--------------•-•---- ...No. Compartments-----.. ------------ ---- ' <br /> Distance to nearest: Well.......------- -._ ._.-----.Foundation..... __ . ...-.. ___Prop. Line._..------ - -------- <br /> LEACHING LINE [ ] No. of Lines . .........................Length of each line,--------.._.----_--_------.Total Length _ ------ --------- � <br /> 'D' Box_........ Type Filter Material........ ..... .._Depth Filter Material.----------_ � <br /> Distance to nearest: Well.........-------...__---.. Foundation.....---------------------..Property Line.........--------.--------_-_-. <br /> SEEPAGE PIT [ ] Depth._-_....___.Diameter..--_-.--r......._..Number_._----------------------_---- Rock Filled Yes ❑ No ❑� <br /> Water Table Depth..................... ......... --------------------Rock Size.......... ..-------., _ cil <br /> t <br /> Distance to nearest: Well._-._.---- ----------------------Foundation-------------... .........Prop. Line_. -.-- <br /> 71/REPAIR/ADDITION (Prev. Sanitation Permit#_.......�P®F......... .. ...... !✓ ..__lc1 _..-.-------J �" <br /> Septic Tank (Specify Requirements)_. -- ---_---p---------___-•------------_- ------._..__-..------------------- ------ ---- ---------- - <br /> Disposal Field (Specify Requirements) BZ--------- -- ------ <br /> -------y <br /> ..........-------------- ---- --- ----------------- <br /> k <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin Count <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agent <br /> signature certifies the following: e <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 ash <br /> to become subject to Workman's Compensation laws of California." T- <br /> Signed-----4-- -- - _ - <br /> igned----- - ._..... -Owner <br /> By.. / .. - Title_... -- .5T. 1. a 7` . <br /> - <br /> & --- <br /> (If other than owner) <br /> R EPARTM T USp ONLY q <br /> APPLICATION ACCEPTED BY...........- . ------------ -DATE .... 5�-fes ._.7./.. --- ....._. <br /> DIVISION OF LAND NUMBER.-- ----------- ---- DATE. -- - <br /> ADDITIONAL COMMENTS ------ --------- .............................. --- . <br /> ------------------------- ......__......... ...----- -------------- ...... ...... ---------------- --------- --------------- .._.. . ---- ...... <br /> ----------------------- <br /> ............ ---_------------- - - _ <br /> Final Inspection by:.............. ---- ----------------__........ Date. - -- -- ---- ----- <br /> EH 13r24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV, 7/76 3M <br />