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FOR OFFICE USE; FOR OFFICE US <br /> APPLICATION FOR SANITATION PERMIT J� <br /> . .. <br /> (Complete in Triplicate) Permit No ................. <br /> --------------------------------- - -------------- - <br /> Date lssued.5.`_�.�� , <br /> ............................... ........................ This Permit Expires l 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: I <br /> JOB ADDRESS/LOCATION......./., ... / ✓ ------------------------------------- ---------CENSUS TRACT................................ <br /> Owner's Name .1.06&...._ 1 ��5 ----- ------Phone__ f_�.ff_ <br /> Address- - - = Yt ' <br /> :.. . zip ---------- <br /> Contractor's Name. i�S-- 6 AG , 41-2 <br /> .----License # JY ..Phone �2---�----- ... <br /> Installation will swve:t w . . Residence ❑ Apartment.House ❑ Commercial ❑ Trailer Court ❑ <br /> �.-. Motel ❑ Other..........:.. = -. <br /> Number of livingunits:.-. ---.Number of be roams... ;? U <br /> Garbage Grinder......•. -Lot Size.::�'.�_!� .��.. - <br /> .•r <br /> Water!Su l Public S4stem and name.. .....- _- ::-,}-.t------_ Private ❑ <br /> PP Y Y �,°� ........ ----------- <br /> € t i Peat Sandy Loam ❑ Clay Loam ❑ �-- <br /> Character of soil-to a depth of 3 feet;' Sand ❑ Si � Clay,❑ �t P � • <br /> Hardpan ❑ Adobe Fill Material.. .-.. +- If yes, type__- ----- <br /> s' ...s. <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: (Nolseptic tank or-seepage-pit permitted if public sewer is available within 200 feet,) <br /> AS- <br /> PACKAGE TREATMENT <br /> [ ) !SEPTIC TANK Size------------------------.--- - -----------Liquid Depth------- <br /> .-.....---.-.----� <br /> Ca acit� -__._.....?' _._.-T e......_.... ... <br /> P Y YP Material--------------------------No. Compartments.......•-•........................ <br /> f. <br /> tl Distance'to.nearest: Well---------------------a:�..___.;_...:.,,.-.......Foundation.......... . .............Prop. Line..-.--...-_------..-..-.-- <br /> LEACHING LINE [ ] w No. of Lines--.—T.._ .----- ::_..Lengthhof each -line............... ............Total Length ... -.---.------:.-:-----..---------- <br /> r ]/ <br /> 'D Bdz---'3_.__..-.Type Filter Material--- - - - .- -.`.Depth Filter Material-- ................................. € <br /> Distance,'to nearest. Weil------------ --� Foundation----_--------------___._.Property Line._.-_-_-.._. <br /> fI <br /> SEEPAGE PIT [ ] Depth____...... 7'_Diameter_,__:___.._.._r;._.Number-_._...---'._------------------ Rock Filled Yes ❑ No ❑ <br /> � Distance to nearest: Well---------F-------- � : . -�-- s � . <br /> Water Table De th------------------- -- ----- - <br /> -....... ............Rock Size. �--...-------------------�-- <br /> ------ ---------.Foundation---------- ---------- -Prop. Line..__.---------- -----.- '�!. <br /> REPAIR/ADDITION (Prev. Sanitation Permit#------------------- '} - .....Date------------------.....----------------- <br /> ------ <br /> ) <br /> Septics ank (Specify Re' uirements)- """�.:��0- _:- • ,a. ---------------- ---- <br /> Disposal Field (Specify'Requirements).... �.fGi1 - ---- ---/7 ----- ------------------ <br /> --- -------- ----------..--.. --- ---------- ----..-------- ------- -------•-- ----•-- ---------- ...... ---------------------------- ................ <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this 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 the following: 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 laws of California." <br /> Signe ----...Owner <br /> Title <br /> own <br /> (!f other than owner) <br /> OR IEPARTM T E ONLY <br />'APPLICATION ACCEPTED BY----- ��// <br /> d^. ..... .,:... ---• --------• ---------- DATE <br /> DIVISION OF L N�D N.UAI�BER._._.r-:--�- _. ...... --------------- <br /> ----DATE=----------1---------- <br /> r <br /> ADDITIONAL COMMENTS.�.�.; __ -------------------------- -- ----- -------- -.:.. <br /> .......-•-------------- ---- ------ - ------ ------------- <br /> ,..f <br /> ----- .... ......................----------.....---- <br /> _ <br /> - <br /> Final Inspeciron b �-- ------------------- -- ------ ----Date ----- �--- <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT f&5 21677 REV, 7176 3M <br />