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FOR OFFICE USE: r' <br /> . ... ... ... ......... <br /> APPLICATION FOR SANITATION PERMIT <br /> ................... <br /> (Complete in Triplicate) Permit No. <br /> ' .......•.. . . ...... This Permit Expires 1 Year From Dote issued <br /> Date Issued fid.` �� <br /> Application is hereby mode to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described.This application is mode in compliance with County Ordinance No. 549 and existing Ru:c- and Regulations, <br /> JOB ADDRESS/LOCATION .12031 .No. Jinnk lone rd. `l <br /> C'ENSLJ.i TRACT <br /> ...:... ................ <br /> �! Owner's Name Pete .Jauregulto . ....... .... phone°312491................. <br /> Address Same ...... _.. ..... . ... .... . City .. ... . . ..... <br /> a <br /> 64 9 <br /> Contractor's Name_.G... Tank Ser. .........License f �.'-: <br /> Inetallotion v,ill serve: Residence{>]Apartment Housoo Commercial QTrollw Court ❑ <br /> Motel Cl Other............................................ r , <br /> : . <br /> Number cf living unite:.. ... ..... Number of bedrooms ............Garbcge Gr'nder .. .. ...... lot Size ........................................... �. <br /> Wote:Supply: Public System and name .............................................................................................................Privoh❑ <br /> C'horocter of soil too depth of 3 foet: Sand j] Silt❑ Cloy E] Peat❑ Sandy Loom ❑ day Loam❑ <br /> Hardpan E] Adobe ❑ Fill Mcterlal .... ..... If yes,type............... .......... . <br /> s <br /> (Plot plan, showing size of lot, Iccation of system in relation to wells, buildings, etc. must be placed on revene sldo.l <br /> a'VJ INSTALLATION: (No septlu tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ j Size................................................ Liquid Depth ....................... <br /> Capacity ................. .. Type ................ portments <br /> .... Material...................... No. Com ................. <br /> pDistance to nearest: Well ....................................Foundation .._.................. Prop. Lino...................... <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 ................ Number ............................ Rock Filled Yes ❑ No ❑ <br /> s� <br /> Water Table Deptb --...._........................................Rock Size ................................ <br /> Distance to nares': Well ........................................Foundation .................... Prop. Lino ...................... <br /> MAWADDIMN(Prey. Sanitation Permitp ........................................... Date ..................................I <br /> SepticTonk (Specify Requirements) ......_.........-------•.... .......................................................•--................................._................. <br /> Dispose! Field (Specify Requirements) .40.1....4'.'....ti ht..LiriP...t.0..3A1.:...1171'.�---Eo?c then 1+Ot Lesch <br /> t <br /> w .... ... di�. leen <br /> .'... .. r48 ........................................... <br /> ................-- ................ ............................ ............................_............................................................................................ <br /> (Draw existing and required addition on reverse side) <br /> I hereby Mortify that I have prepared this application and that the wait will be done In octerdonce wllb San Jissilllobl <br /> Const t Ordinances, State Laws, and Rules send Regulations of the San Joaquin Lecd HOW* Distslct.Remo owner M BOND- <br /> sad <br /> kon►sad agooft signature certifies the following: <br /> "I codify tfsat in the performance of the wait for which this permit Is issued, I shot) not employ any porsaw M suede nsssweir <br /> as to boco"w subject orkmon' mpensation laws of California." <br /> Signed........... ...... ------- ... ...................---- - -----.....----- Owner <br /> -.... ........................... Title . ...Ov aer.................................G p C Septic T�.nk der. <br /> By..... ..... .... <br /> I other than owner] <br /> �a� <br /> FOR DEPARTMENT USE ONLY _ <br /> APPUCATION ACCEPTED BY L'.... .:.. . . ....... DATE ftl �.�. .j!i..... . .... <br /> BUILDING PERMIT ISSUED ........................................ .. ..........................................................DATE . . .. <br /> ADDITIONAL COMMENTS t' <br /> :.......5... -•.......................... <br /> ....... :..... _....... .. ..................... ... ...................Z.... .............. <br /> Final inspection by: .... .�s: . ........................................................ ........... .Dote..��/. ... ......... .... .... <br /> EH 13 2!i 1-68 Rev. 5�S SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 3PI ,r <br /> A. t' <br />