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05; 6� IF <br /> 140"FO R OFFICE USE:___�i� <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT N 7 <br /> Permit <br /> ------------------------------- - (Complete in Triplica i' <br /> :pate I/sui�eed ----------- -- <br /> ------------------------ ----------------- ------- ------ <br /> - <br /> ------------------------ This Permit Expires 1 Year Fir Dot lssuq <br /> 4, tail) wor stein ascribed. <br /> Son t <br /> is hereby made to the' Joaq Min �odrcll Fea% District or per <br /> n <br /> Application _60 u n t <br /> This application is made in compliance with y Ordinance Na. 54 and xistin I S I R r.00 <br /> .................... <br /> TRACT._------------------------------ <br /> JOB ADDRESS/LOCATION 7 -- ---- —--- ---------- •------!r--------- -------- ------ A. _-CENSUS <br /> 2VS17 <br /> ----------Pho6e-------------------------------------- <br /> bwner's Name- ...... ------------ --- ------------ ----------------- -- -- ------- - --------------- -------- <br /> -,W� l <br /> d'dress----Y01 ------------- ----------------7 --f7 ...... C ity-.,Oru-ar-4 400V ------ <br /> #----------- ------0---------Phone4-- ------------------------------ <br /> Contractor. Name---- -------------- -------------------- ------------- License <br /> s N - ------ ------------- <br /> Commercial F Trailer Court D <br /> Apo men j <br /> f. <br /> Installation"will...serve: Residence Nr tiHous <br /> Motel [:1OA0-- ---- --- ---------- - --- ---------- <br /> 6 --- -- <br /> k . I X ------------ ----------- <br /> 'Garba _Lotr.Size_../ <br /> ber f.bedro ge Grinder---- <br /> ,N.*Omber of living units:--,/--------Num o i <br /> t I I I Private Fj <br /> I __------- --- -------- ----------- ------- ------------------ <br /> ame -------- -- ------- <br /> Cter Supply: Public System andn ----;-------------- <br /> P <br /> Clay Loam D <br /> 'I C.6 Peat ❑ Sandy Loa <br /> 'I <br /> aciracter of soil to a depth of 3 feet, sand E] St e.ly <br /> ­1. i ---- ---if yes, type.-._--_- -------------------- ---- <br /> 0 - <br /> H cird�ci� r] Ad -be El <br /> 'j must be <br /> p3ls, builflings, etc.'mu placed on reverse side.) <br /> {Plot plan, showing size 'of lot, location of system in relatio' tow. - I - <br /> k& C qi�q I availablewithin200 feet,) i <br /> ,NEW INSTALLATION: `0(No ieptic tank or seepage pi MiW�If publi&weir is civaila <br /> Liquid Depth._ —--------------ty <br /> ------------------------------- -- Liqui <br /> TREATMENT SEPTIC TANK- [11 <br /> PACKAGE ------ ------------------- <br /> j. ------------------------ <br /> --- - <br /> P??city` -- - --------1, M No. Compartments_ <br /> Ca 1 C't <br /> �rXIT7 <br /> Ka*nce'.to nearest: Wel.l.'--- ------------- -- _ --------- -,Foundation-- Line.__._- -------------- ---- <br /> --jotal Lenigth <br /> -------------------- <br /> ---------- <br /> LEACHING LINE: X No, of Lines------/-------------'!------Lendth of eaqp line <br /> 2-�Mpttllk Filter ter.al---- <br /> ------1_._.,--1-1--------------------- ------------------- --- <br /> i. D Box._- --.._Type/--..-Typ: e F:Iter Materia/L �.?e//i <br /> ---Foundation/d------------ ---.Property Line.------------ - ------------ <br /> Distanceto nearest: Well_;----------------------- <br /> No[] <br /> ------ ----Number--- ------------------------- Rock Filled Yes E_ <br /> SEEPAGE PIT j Depth.-- ------`_.".Diameter-------- <br /> Size--------------------- -------------------------- <br /> Watee -------- ------------------ ------ <br /> r Gle"bpth-_' ----------- ---- :---Rock. <br /> 'd r <br /> Distance to h'e&6�f:Well_'-------L------------:--------------------Foundation -"-.Prop. Line---------------------------. <br /> REPAIR/ADDITION (Prev. Sanitation Permit#--'--- --------------------- -"_Date-------------'-- --------------------! <br /> ---------------------- --- ------------------------ ------------ <br /> Septic Tank (Specify Requirements)------------- ----------------------- -------------------------------------- <br /> --------------------------------------------- --- <br /> Dis'poscil Field (Specify.Requirements-)----- --------- ----------------------------------- -------------I------------- <br /> ------------------------- <br /> ----------- <br /> --------------------------- <br /> ---- -------------------- -------------------- <br /> --- <br /> =----------------------- <br /> ----------- --------------- ---- <br /> ---------------------------------------- - ------ <br /> ------------- ------------------------- ------------- ------------- ---------------------------------------------------------------------------- --- <br /> (Draw existing and req6ired addition on reverse side) <br /> I hereby certify that I hciye-preparecl this-application and that the work will be done in accordance with -San Joaquin County <br /> Ordinances, State Laws; an Rules les and Regulations of. the San Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies thn following: <br /> in such manner as <br /> in i issued F shi3ll not p lo' any person"I certify that-in performance of the work f6e'which this-' y <br /> permit i <br /> S/ <br /> �t <br /> t t <br /> tc laws of California...... <br /> to become sub' t to W km �mpensation: T <br /> C,;Vo nor <br /> w8w <br /> ---------- -- ------- .... . ...4 <br /> Sigped_____ ---- ---- ------------ - ----------------- -------- ---- --- <br /> 7 Title----- ....... <br /> --- --- -------- <br /> By-1,--------------------------------- ----------------- ----------------------- ---------- <br /> 'jif other than owner) <br /> . . ... /-7 FOR DEPARTUSE NLY <br /> ? <br /> DU!_ -P <br /> DATE. V_ <br /> L CCEPTED ------ - .. ---- ---------- ........... ----- <br /> APPLICATION-A - - --- ----- ---- <br /> ATE--------------------- ------- ------------r----- <br /> ------ <br /> DIVISION OF LAND NUMBER..------------- ----- ---------------------------7 ------ --- <br /> -------------------------------------- ------------------- --------- <br /> ADDITIONALCOMMENTS---------------------------------------------------- --- ----------- --- --- 4 <br /> - _:. - - ------- --- - - --------- --- -- ------------- --------- -----------:--------------------------------- - <br /> -------------- ---------------------------:--- ------- --------- ------- ------------ <br /> --- ---- ----- ------------------------ -- ----------------I------ --- -------:----------------------------- - <br /> -- ---------- --------- ---------- ----------- - ------ <br /> - --------------- 4- --------I-------- <br /> - ------------------- ----- ----------------------------------------- ------------------------- ------------- V01-71 <br /> ----------------------- -- ----------------- <br /> ------------ - <br /> ------- <br /> ---------- ---------------- -------------- --- <br /> FinalInspection by------------- ------------ ---------------------- --- -------------- ----------- ------------------- <br /> F&S 21 677 <br /> EH 13 2A SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> .......... <br />