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�. t \ <br /> FOR OFFICE USE: <br /> FOR OFFICE USE: APPLICATION EOR SANITATION PERMIT •T� - <br /> r Permit No.- 1__a. -- -- <br /> {Complete in Triplicate) <br /> f/ _ Date Issued-..--------y-----r7� <br /> ----------------------------- <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made tothe JwiaiI ountylOrdinance sNo. 549 and existing Rultrict for a permit to tes and Regulations:ruct and install the work herein described. <br /> This application is made in compliance <br /> N 757Z ------ -------- ----CENSUS TRACT <br /> JOB ADDRESS/ OCATIO --- -- .-- <br /> 3------------------------- <br /> Owner's <br /> ��z <br /> Phone Z - - .------ <br /> Owner's Name----------------- k <br /> r - � � --- ' r <br /> Z <br /> � <br /> 77tf-.� �.1` t - <br /> _--- - � � � �' Phone X607 <br /> Address---- -- ------------------------------ <br /> --- <br /> Lsense #.- --. ------ -----`--- <br /> Contractor's Name - <br /> COMM•• -�� -° ommercial Trailer Court ❑ <br /> installation will' serve: i Residence Apartment House❑ ❑ <br /> . �-Motel-©--•-©they---- �. -- <br /> 'Z� Lot Size '--�o- -x lf_ -- -- <br /> M _____ <br /> i Number of living units----- -- -------Number a rooms-.--- -- -Garbage Grinder .� - t <br /> 5 <br /> Water Supply: Public System and name- :- � <br /> �f <br /> Private <br /> Pp Y° - a Loam- <br /> Character of soil to a depth of 3 feet: Sand ❑ =,...Silt-9- -Clay❑_ Reat S -S �lr�loa►r�❑ y' <br /> . r s <br /> t Hardpan ❑ [ Adobe FiIIE+AateriaL--- If yes, type_-------_ --� <br /> l------------ ! <br /> (Plot plan, showing size of lot, location of.system rn reiationato wells, buildings, etc,must betpj ed-arrrev s "side.) 1 <br /> it permitted if public is�available within 200 feet,' <br /> 4 w <br /> NEW INSTALLATION: �(No septic tank or seepage p' p p <br /> A --Liquid De th._-- -------= <br /> SEPTIC TANKI Y I Size.-- ------` -�. �� . q <br /> PACKAGE TREATMENT"'[ ] i 11� r <br /> i �+. 3 <br /> T e No Co' .p rtments <br /> Capacity: i/ == yp:- -:- -_ . � �. € S <br /> t Distance.to nearest: Il-.Lr,_ --_--_- Foundation-_� ` Prop: Line-------------- <br /> Materia --- <br /> } S <br /> SD---__-.Total Length.-_ r - <br /> � -i_ "--__-en fih of each_line.__ - - .--- -- <br /> LEACHING LINE } No. of Lines. i .,: g <br /> - <br /> ®,�,,� De th Filter Material-- 18---------- --- <br /> YP Mat1riol'-f-�-'�1eA_. p ,. ,. f <br /> .D' Box -- ._ :�_T a Filter - <br /> Distanceto nearest: We11_ �� <br /> �._,. t <br /> .----`}�----- �. Foundation �- -- - -------- ------ Property ..me-- � - N <br /> l Roc <br /> F <br /> 'SEEPAGE PIT [ ] p}� {i rli-fid-- --Number ,� } k Filled Yes No E] <br /> De th___ - Diameter _ ± <br /> - 1 /r <br /> .. t -�- -.-Rock Size n�,�-- <br /> i I Water Table',Depth---- -- ----------------------- ---------------- F <br /> x . . . Distance+to nearest: Well._, -, Foundation -- ------=---------Prop. Line---------- -------------- <br /> - <br /> ' -----.Date ------------------------------ --------- <br /> t <br /> I REPAIR/ADDITION (Prev. Sanitation Permit#-------= -- -=-- <br /> ----------- - <br /> s ------------------------- <br /> ---------------------- <br /> Septic .- <br /> Tank (Specify Requirementsy�-------- -_-- - <br /> _ . -------------------------------- <br /> ---------------- <br /> ---- <br /> � . z <br /> 1 .------'-------- <br /> ---`- ----= ----- �. „ I <br /> Disposal Field [Specify Requiremets)-- -------- - -- - -------------------------------- <br /> ----------- <br /> ----------------- <br /> 1 ----- ----- ---------- <br /> ------------ <br /> --- _ <br /> -------------- <br /> ------------ <br /> -------- <br /> ----------- - <br /> - -- <br /> -------- ------- :- t . . -.- <br /> t '� +.-.3� t ----------------- --------- -------------- - ------ - :----- ------------------------------------- <br /> o L'- t <br /> [brave exisFing'gnd required addition ori reverse side) <br /> With San Joaquin County <br /> 1 hereby certify that I have prepared this application and that the work will be done in 'accordance <br /> Ordinances, State Laws;-and ARuI'es and Regu11tions-of-the-Sari-Joaquin-L-oial-Health•ilistrict• Home owner or licensed agents <br /> v e: <br /> signature certifiel the following: <br /> "I certify that in`the perforii+ance }of'the:work for which this permit is issued, I shall"not employ any personin such manner as <br /> I to become. subject. to.,Workman's, Compensation laws of California." <br /> Signed <br /> fi ---- <br /> By ----=- ------ �1� : <br /> � � <br /> { other thdn owner) ; <br /> c <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY= = A-----------------:-------`---- <br /> :---- -- TE <br /> DIVISION OF LAND NUMBS -'- -. l A <br /> -- / <br /> ADDITIONAL COMMENTS - - - <br /> <x ------- - -- - ---- - <br /> --------------------------------------= -- ----------- <br /> ---- <br /> --------------------- <br /> ----------------------------------- �. _ - <br /> Final Inspection-by --------- ��- �, - ------------------------ <br /> F&5 21677 REV. 7176 31 <br /> EH 13 za. SA JOAQUIN LOCAL HEALTH DISTRICT <br />