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l FOR OFFICE USE: <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. _7?---- / <br /> ------ (Complete in Triplicate) <br /> ---------------------------------- - - <br /> IN Date Issued-:- - ..------- <br /> This Permit Expires 1 Year From Date Issued <br /> •" - G or and existin <br /> Application 1s hereby made to the San Joaquin Local Health District Sfor a permit tog,oRultes and Regulations:.ruct and 'install the Work herein described. � <br /> pp� is made in compliance with County Ordina c� <br /> This'app �- _ <br /> y <br /> lication . ------ <br /> Phone--- <br /> -- <br /> kCEN ------- <br /> - - <br /> - �k: -�- -�-----=-- -------------------- ._ �y1 S <br /> USTRA <br /> CT <br /> JOB ADDRESS/LOCATION------------------_ - - ------------- ------- - Phone <br /> ---- ---- - <br /> - ---- <br /> Owner's Name. = 0 :-- - F- -- __ -- - ---- <br /> _ - <br /> Zip.--------------------- <br /> - city <br /> Address- - w , <br /> ame 3GLr� Phone- <br /> • ..:. - � - ----- _License!, --- <br /> fI Apartment # <br /> Residence p it <br /> Contractor's N -��'-� - -- � - �� :�, - <br /> ment House❑ Commercials❑ Trailer Court ❑ <br /> Installation will' serve: <br /> tel+ ` �. .__G' <br /> arbage Grinder _ <br /> .,�.a.�. .�_ ❑ - - -- -- -- <br /> - Lo <br /> T---�- O F - - � t;Size. <br /> Number of living units:- --------------Number of bedrooms__." -- � ,, � -. --' private <br /> .� _---San <br /> �q <br /> t name -- -,:. ; . <br /> -Water Supply: Public System and -- <br /> r Peat ❑ ldy Loam ❑ Clay Loam ❑ <br /> Sand Silt❑ Clay ❑ . <br /> Character of soil to a depth of 3#eet: G �, _ t Yes, <br /> el . -----_----------._ <br /> Hardpans - dobe❑ Fill Mater+a-l_-._-- -_ -If typ El-- -- <br /> Fi size of lot, coca iQn of system relationito wells, buildings, etc mus <br /> in <br /> on reverse side.} <br /> (Plot plan, showing d t, l �� , <br /> s- ,_ �.. <br /> NEW INSTALLATION: (No septi :lanl or seepage pig permitted if pubic sevr a+ ablswithilnlaD�fDe feet,) <br /> th _ "" <br /> ___ <br /> +?. ss� '`+� . ...Size <br /> -------------------------- <br /> rSEPT41 <br /> I' TANK, 1 .1- <br /> . PACKAGE TREATMENT Ili r E� No. Compartments------------------------ - -- - <br /> G 4:: S � . <br /> • Material-- -- - -- -- ; <br /> .Ca ac�iity-,_ ____t-==---`--, TYpe,` h <br /> iX_`- t -`' .'`. = Foundation- - Prop. Line -- - - - -- -- • <br /> Distance to nJ8r.esi: We�II_-- r , <br /> .< <br /> 1 r` No. "of Line _: _` '?_-5 Le#gth of bine. -.--. ------- <br /> ------Total Length .. - ; <br /> LEACHING LINE-.0 p] s : I . <br /> . .,a rial-J--`` -- Depth Filter Material. - --- - - <br /> Ry p t. ..V <br /> D' Sox"---- -T' Filters ate _ , <br /> 4 -- .: Y <br /> .,_ _.Foundation_ _ -_ Property Li <br /> -a DistancelCi nearest Well `� ----- R e <br /> led <br /> _..� ack Filled <br /> es ❑ <br /> 4` <br /> r v,. .. ---Number <br /> j <br /> SEEPAGE PIT [ Y Depth 4 e --------------------------------- <br /> ------------------------ -�. F ,_ - Rock .Siz - , <br /> Wafter Y7able.Depth <br /> Distance to nearest: Well. F- `:--------- ;- -Foundation._ __ Prop. L' <br /> ne <br /> --- <br /> f f t-----------�`------ Date_R'.._ ------------------- <br /> REPAIR/ADDITION, <br /> --- ---------- 1 <br /> REPAIR/ADDITION (Prey:Sanitation Per-,mit#__? -.�_— s <br /> S f c <br /> SepticiTank (Specify Req u+r �n �c. - - .- t pr f t <br /> r i ------------ <br /> 1 <br /> i "3 ---.---�--_ <br /> j Dis,po"sal Field.(Speclfy=Requirem ts1- l_- - ------------ <br /> ---------- <br /> -_ ----- .-- -:---------------------------- <br /> ----- <br /> --- .- ------------------ <br /> -I = ----. <br /> t -y - _ - - ---- - . . <br /> i - ' ______________ <br /> '. _____.--__r____-__ _ <br /> g he work will <br /> reverse side] <br /> ---------- -------- ---------------- -=--------------- <br /> " (Draw existin. and required addi#ion <br /> I+ication'and that-the ill be done in•accordance with San Joaquin County <br /> hereby certify That I have prepared chis app 1 <br /> Ordinances„ State Laws, and Rules and Regulations of the San Joaquin Local Health.District. Home owner or licensed agents <br /> I I , <br /> + signature certifies,1he folio ing: t � ersori in such manneras <br /> .,,. t <br /> "1 certify that rh he pe ormcirite of the work for5,w,hich4 this permit is issued,:) shall not employ any p <br /> to become. subject to -Workman's Compensation 164s of 'California." j <br /> Signed ------------- -- <br /> --------------. .. <br /> s:� <br /> = T <br /> caner <br /> i itie <br /> ;. <br /> t (If other than owner) <br /> I <br /> FOA EPARTMENT USE ONLY <br /> €� <br /> _-DATE. 7 <br /> ----------------------- --=-------------=---------- <br /> APPLICATION ACCEPTED BY_.____._-._ _ <br /> -------DATE---- ---- -- ------------------- -- ---- ---- <br /> DIVISION OF LAND NUMBER ------- <br /> 11 <br /> 1- --------------------------- ---------:-------- <br /> ------=-------------------------------- <br /> ADDITIONAL COMMENTS 1. ------------- ------------------ -- <br /> ------ ---------------------- <br /> _____________________________________-._.____--____.-.____-.-___ __________-.______.___ _ ---_ -_ _-.-_------ <br /> -------- <br /> - __- <br /> ___________________�--_.___._-.__________-______..__ l// -_-__ __ _ <br /> E -------- ,, Date <br /> Final Inspection b --- - i s 4677 REV. 7/76 3M <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT <br />