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y > . <br /> FOR;,OFFICE USE: v FOR OFFICE USE <br /> APPLICATION FOR SANITATION PERMIT <br /> (Com le Permit No.------------ Jam` r <br /> p te,in Triplicate) •---- <br /> ------------- ------------------------------------------ <br /> Date Issued-...� _' �-7 <br /> ----------------------- - --------------------- This Permit Expires 1 Year From Date Issued <br /> to <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal[ the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: , <br /> JOB ADDRESS/LOCATI N. � d'(1 - �` <br /> S TRACT---------- ----- --------------- <br /> Owner's Name------- --- .-_,. �_ <br /> / C.% ---- -- --- -------- -- ------ = = Phone--------------.- ---- ------_-------- <br /> Address ,/ __..- { i City ---------- ----•------- --- - <br /> G - - ----- -- ZAP- -{__ r <br /> ..4 <br /> Contractor's Nam rL_ ._. .__ icense # =2:Q_ <br /> _. r- -- ---- ---- � ----- - - - --��- �-. -----7--7 Phone_ <br /> Installation will serve: Residence Apartment House.❑ Commercial ❑ •Trailer Court, ❑ ` <br /> ' Motel ❑ Other- ------ ---- ----------- <br /> Number <br /> ---------Numbr of living units:__._r=------Number of,bedroa _ _ -Gprba eeGrJr er. lot Size--- . _ IYAC�11 ...... <br /> ' <br /> PP1y: Public System and name-- ---: -- ---------------':---------------------------------------------- ------Private <br /> CIharacter of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat� Sandy Loom�OClgy Loam __, <br /> i 4 �" �. _-„Na�dpan;❑ �. Aore <br /> Fill-Mat <br /> e yes;tYAe --- i. <br /> e I.. <br /> (Plot plan, showing size of lot, location of system i'n relation.to wells, buildings, etc. must be placed on reverse side.) <br /> i NEW INSTALLATION: (No septic tank'or'seepage_pitF erm.Otte� f'public`sevver is a�a.ilable within 200 feet,) I ,� <br /> PACK;4Gl: TREATMENT”-[-1' _SEPTIC-TANK"�[T �- p ____._ <br /> Ssze Materia_I----�----'=-----'-------No------� �iquid'Depth --------�-----;�`s <br /> I € Capacity._ -------------- <br /> ------- Type----- ---- --. . Co pa tments_ttt----------- ----- <br /> .. Distance to nearest: Well--------------- ----- --'.- r Foundation!-"- p.<Line�,:-_----- `' <br /> --- ---- <br /> r LEACHING LINE No. of Lines-.------- __ <br /> [.------Length� of each`hraa..____ __� TotahL�ength <br /> 'D' Box_ `-Type Filtgr�lAa.ter-ial —Depth-Filter-Material -L i' Pd <br /> Distanceto nearest: Well-w!----Foundation._ Y---_ ---Property Line.._4-.-_-_-------------- <br /> I SEEPAGE PIT Depth pZ_' Diameter . Number ______: Rock Filled Yes No El <br /> t Water Table.Depth — ----'�----- a- - R4oc'kSize�© ------------ ---- } -------- f <br /> S 3a ® <br /> Distance°to nearest:`Well -------- ------- e *Foundation__._. <br /> 1.,� --..Prop. Line------ --------- ---� i <br /> REPAIR/ADDITION (Prev. Sanitation Permit#_______________'-'--_- _ ____-_-Date_:____._..___._____ ' <br /> Septic1Tank {Specify Requ.irements)----- ------ --- �:r= - e+>-_ ----- ------------------------------------------ <br /> ,. <br /> posai Field (Specify Requirements) =-- - - - -------.= <br /> sus <br /> U. . ------------ <br /> -------t: — F <br /> -- ---- <br /> . v (Draw existing and-required addition on reverse side) I } <br /> I hereby certify that I have prepared this applicationend-that-the work will b-eTdone-inaccordance with-5an Joaquin County <br /> Ordincnce-s,,State Laws, and Rules and Regulations of the, San Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: c <br /> "I certify that-in the performance of'the work-foi which this permit is issued,-I'shoil not employ any person in`such manner as <br /> to become :subject to .Workman's _Compensation laws.of California." <br /> i r gpT "'- 'RV t <br /> --� " ,Br.F3 S iC� S��;tR S IC <br /> Stgned-" r - <br /> ----------- `3 -` _Owne.r <br /> .r ��- . .---- - .. .- �- .. ._. ��Gv �o. cici: Calif *_ <br /> By_!------ ----- -- Title ' �� r ren I ilj.7 € s <br /> �` itl ?1 trsct�r' it 4,'O A. <br /> I ` (If other than ow r) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--.-=-- -- -cfJ-- ----------------------------------------------=-------- = DATE- --/ - 7 '------ <br /> fllVISION OF LAND NUMBER - DATE ;----- <br /> E _ - _____________________________ <br /> ADDITIONAL COMMENTS--- -f�. - a� -Y. <br /> - _ _____�_- <br /> -- <br /> --------------------------------------------------q-------- ---------------------------------------------•----------- -------- -------------------- --------- <br /> -------- <br /> ------------------------ <br /> Fina[-Ins ection b �� - - � --- - -- - ------•------------ ------------------------- -- -- <br /> -- --'-------------=-----_=------ ------------------------------------------------=--------Date.---� --lam 7 <br /> P Y = -1?- -------- <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 216��/76 aM <br /> k <br />