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fes' FOR OFFICE USE: <br /> FOR OFFICE USE:: APPLICATION FOR SANITATION PERMIT `,`S If' <br /> .� �. Permit No----------- -- <br /> 7.------- VIP---------- ---- (Complete in Triplicate) <br /> ---------------- - <br /> -------- Date Issued - <br /> This Permit Expires 1 Year From Date Issued <br /> ---•------------ i }� <br /> y4 vs- ` <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and,install the work herein described: y <br /> This application is made in co lion h County Ordinance No. 549 and existing Rules and Regulations: <br /> TT � - <br /> y <br /> r '2 �} � � /f0 f CENSUS'"TROT.- --- <br /> q r <br /> ,--*B,ADD.RESSILOCATION -----,' - /' <br /> k <br /> t)Ttf�•��T# ---------- Phone <br /> Owner's Name.= s_. .- - r p <br /> S <br /> -- _Y�o -- l - ael�+_ .q' t -'---- -- P. <br /> Sn ; License #----------- --- <br /> Address...-- y s / I 1 <br /> Contractor s, Name----------- hone--------------------- <br /> } <br /> l <br /> T I Court' <br /> Apartment House. t Commercial ❑ rai er ❑ <br /> Installation will serve: Residence ❑ p �,�� <br /> = G y ' <br /> 1.� Motel ❑ Other t <br /> N tuber of living units:_- -s------Number of.bedrooms�__3_-- Garbage Grinder-------- ------------ f� -------.y-���---- t----------- <br /> Number <br /> ---- ---- . <br /> Pr e <br /> Water 5upplty:-Public System and name._-: :,-.,I-------=---- ---- ---- - ' <br /> is <br /> i Peat❑ Sandy''Loamj❑ ;Clay Loam ❑ ` <br /> Character of.soil to a depth of 3 feet: Sand,j� Silt❑ Clay ❑ I <br /> -If es, a----- <br /> ► Hardpan❑s Adobe❑ File Material-.___-.--- Y type - # <br /> Plot Ian, showing 'size 'of lot, location of system in relation to wells, buildings, etc.`must be placed on reverse side'} <br /> ( F p 4. a � <br /> NEW INSTALLATIONi' !(No-septic tank or seepage keit permitted if public sewer is availa1. <br /> ble within 200 feet,} I <br /> 'S'' '`.)'S-� "Ir � -----------Liquid Depth ,-------- <br /> SEPTIC TANK •[•] Size--------A------- -- <br /> PACKAGE TREATMENT" [ ] ` <br /> �O�•�L. �y- - rfg3T-Material o«`��------No.• Compartrn is <br /> 1 t •Ca acit ---------TYPe --= u- <br /> { a ' ! X 3 ------------------- Prop. <br /> . -.. Distance.to nearest:Well.- ._ ~- _ <br /> ---------- <br /> :Foundation------! <br /> = = <br /> No.,of Li.nes.,_-! Ter Be Length of each line. -- -----Total Lengt __ =----- - <br /> - - <br /> LEACHING LINE [ ]. �� ! a <br /> /�p -----Depth Filter Material --- Q <br /> -- <br /> :'D' Box---_V ''--.T a Filter Material _- -- - ----- <br /> :. Yp s _- /a Property Lune-- � - -- i <br /> 'Distanceto nearest: Well ---------------------------Found <br /> at,on- p <br /> 1. }. R Filled e ❑ N <br /> .;_-Number - - - ------------ <br /> Depth.---' l <br /> SEEPAGE PIT [ ] - - Diameter ------ <br /> Rock led , Y '❑ <br /> : ... v: 1 <br /> -- o <br /> s \ <br /> - Rock Size----------- ---------------'i•----------- -- <br /> + Water Table;Depth---=--------------------- X <br /> , - • ' .,_- ._. -Foundation------------ --�i---.----.Prop. Line ------------ <br /> Distance to nearest: Well �------------------------ - , ;.- <br /> Da —� _. . <br /> l _ } -� ---- to j" ------ <br /> n <br /> - 1 <br /> REPAIR/ADDITION (Prev. Sanitation Permit#------- -- -- -------g- ----- <br /> 1 `r( - -- ------------------ <br /> ------- ------------ <br /> Septic Tank (Specify-Requirements)-- -- } <br /> j I <br /> ------------------- <br /> Disposal Field (Specify Requirements)_.---_- .-- _-.- - s - <br /> ----------- <br /> ---- <br /> --- -- ---- -= ` -- - y`r,a�i- -, --------------- <br /> --------. . ;_ � f <br /> ' .. -------------------- - 3` --- -i y }�1 #: <br /> k -' <br /> (Draw existing and required "addition on're reverse side) `. <br /> I hereby certify that I have prepared this application and that the 'work will-be done -in a �ordance_with.San�Joaquin County <br /> Ordinances,:State Laws, and Rules and Regulations of; the San Jo q} l 1 Heath Jdlstrctgkame owner or licensed agents <br /> signaturNJ <br /> e certifies the following: <br /> , . which This ermit is issued, I sh ll �sfi`ernploy`any .person-in such manner as <br /> -I ceitify that in the performance"of the work for R t + <br /> to become, subject two/Workman's Compensatio4m laws of California " � = <br /> A-11 /JO�'� `1L- SAIY -. .- ----OWRer 1P �.�,L <br /> Signed �r <br /> l Itler --- -- -- - - --- <br /> I B �� - - -------. �3 T - F <br /> : - han owner) c ry �---- 1 <br /> .. .. . <br /> �a � •• "FOR-�DEPARTMENT USE ONLY � <br /> 1 l <br /> DA E.---.:/ ------- <br /> ___DA 7 : <br /> APPLICATiON ACCEPTED. BY--------------- - <br /> -=------------ <br /> ------- -------- - <br /> DIVISION OF LAND NUMBER.-------:---:.------------------------------ ----------------------- - -DA. ; <br /> l - -------------- --------- -- <br /> ADDITIONAICOMMENTS---- ------------------------------------ --------------------:= -------------------------=----- t ' , ------------------------- <br /> ------------- --- - ---- <br /> ---- ----------------------------------- ------ ---- - <br /> _ <br /> Dia <br /> -------------- <br /> ------ <br /> . <br /> _---__--"'--- <br /> ---------------------- <br /> -- -- <br /> - _ �r <br /> Final Inspection-by°'-�- ------ <br /> "" -- F&5 21677�REV. 7Z7!L3h <br /> EH 13 24 SA JOAQUIN LOCAL HEALTH DISTRICT r�/f� <br />