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FOR OFFICE USE: ✓. �' FOR—'OFFICE'—USE. <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No.,2ff/-p_2r/ <br /> - •----------------------- �--- - - �- - - �� Date Issued_/.;�al.�S" <br /> ............................... .................. This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to.the San Joaquin Local Health District fora 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 Reguiations: <br /> JOB-ADDRESS/LOCATION 73 -5:...A/Q`//1F/EG,/� 5'"7`Kifl `�= CENSUS TRACT:_. <br /> t ---- <br /> Owner's Name......X/ S/.4..y..--SfZ?/_.T� = c/8Z - X7'754 <br /> ----- - ......--Phone ---- -------- - ---- <br /> Address-------------- <br /> City..:--=-• ------- ....... --zip--------------- ------- <br /> Contractor's Name.... ---PKR/517 ---fir_ SOUS . - �� 313. .Phone..: -90- .. . <br /> ............ ........... ............ License <br /> Installation will serve: Residence's Apartment House❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other ------ <br /> Number of living units;.._.L--------_Number of bedrooms...z--....Garbage Grinder------------Lot Size....._.5O XZOO <br /> ................ <br /> Water Supply: Public System and name ....... - --- ---------- ............ .- ----.Private ❑ <br /> Character of soil to a depth of 3 feet: (Sand ❑ Silt ❑ --Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe Fill Ma't'erial. ...If yes,,type-------------------- <br /> (Plot plan, showing size of lot, iocation.of system in relation to wells, buildings, etc, must be-placed on reverse side.) W . <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] • . N) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size....... <br /> `....... � --------------------------------- ----Liquid Depth.--- -------- <br /> EX/S7741' 6 Capacity...._ ..............Type---------------- --- --Materible------ --.-No. Compartments,.---------- -------- ------ <br /> Distance to nearest: Well---•----.--.. ...... ...... .... .........Foundation.......... . ... Prop. Line.-......-.----.----------- <br /> LEACHING LINE [ ] No. of Lines ------------------------­----------- Length of each line..:.:.- y:=:--------- ---Total Length .. .............................. <br /> EK/ST/*?, 'D' Box---- ..Type Filter Material........ ..... .... Depth Filter Material.........--•................................-.................. <br /> Distance to nearest: Well---------- .............Foundation----.---------------. Property Line------- ------ ---.--:------ -.-. <br /> SEEPAGE PIT [ ] Depth.. ............Diameter.............-.----- Number-------------------.------ --- KRock Filled Yes ❑ No <br /> WaterTable Depth-------------------------7..... ...........-. -----------Rock Size..... ..............---........-------------- <br /> Distance to nearest: Well--------------- ---------.Foundation......_-.......... ......Prop. Line......................... <br /> _ <br /> REPAIR/ADDITION (Prev. Sanitation Permit#--------------6 98.. . . .......Date.................. ........--......-.._---.-M <br /> Septic Tank (Specify Requirements)-- ---- -------------------------- I <br /> Disposal Field {Specify Requirements)--eA15T1qGL__.3.3-"_Xe•7S- P17- L�®.' <br /> -/ t <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: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not ernplay any person in such manner as <br /> to become subject to Workman's Compensation laws of California." <br /> Signed------------- Owner <br /> By............... P . . Title ----- -- .T.-! 'fc TQ�2.-- ----- ----- <br /> (If other than owner) <br /> FO DEPART ENT USE ONLY <br /> APPLICATION ACCEPTED BY-..---. e .. .. .... .. ... ... .. -------------------------- DATE ........ Z.. ..-I�.. _Z <br /> DIVISION OF LAND NUMBER. _. ........ { DATE. ........ .............:... <br /> ADDITIONAL COMMENTS....!. �2d.�7 j^'f ...a oi. _ <br /> ------------------------ --- -------------- -------------------------- --------- -----..................... <br /> ---------•-..-.--•---------- ---- --- <br /> Final Inspection by-=-------- ------ - `p• _.... ry pate. .. ��. <br /> .. o` Z <br /> EH 13 24 - SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21b77 REV, 7/76 3M <br />