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FOR OFFICE USE: _ FOR OFFICE USE: <br /> "APPLICATION FOR SANITATION PERMIT <br /> ------------------------------------------------------- <br /> F (Complete in Triplicate) Permit No.,79-_$: G_ <br /> Date Issued_/___-/----_-_� <br /> ----------------- <br /> --------------------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> F Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION-.___-- _ __, _. _ C./ r�a_-----------1----A--- _-111 _._�-------- ,,.CENSUS TRACT------ ------------------------- <br /> Owner's Name.j. Phon <br /> Address t - --------------------------Citylv.4w �G-A-----------------Zip-- <br /> i. �.� <br /> Contractor's home- � � �- -----------------------------------License #---- <br /> ---------------------- --Pflone <br /> 54MApartment <br /> ❑ .- Other;-------�- ❑ ---= .er Court ❑ -. <br /> Installation will serve: Residence A artment House Commercial Trail <br /> ---- '------------------- .. C-7 <br /> Number of living units:_.' .._-------Number of bedroom -Garbage Grinder._._____ -_Lot Size----- ___.__.___ ________________________ _________ <br /> Water Supply: Public System and name ------- ----- - - ------------------------------ -- ------ ----- ----------------- - ---------Private . <br /> f _. <br /> Character of soil;to a depth of 3 feet: I Sand ❑ Silt ❑ Clay ❑ Peat❑ Sandy Loam$ Clay Loam [ <br /> E Hardpan ❑ i Adobe.❑ Fill Material._._.___,__If yes, type_______________________________ f <br /> ! (Plot plan, show ng size of lot, location of sysfem in relation to wells, buildings, etc, must be placed on revers side.) [ 6\ <br /> I NEW INSTALLATION:"' (N6°septic ta nk or seepage- pit permitted if public sewer is available within 200 feet,] 0 <br /> t PACKAGE TREATMENT { ]' SEPTIC TANK [ ] Size____________________ Liquid Depth.- <br /> Capacity'.--.---Capacity. ' ---TYPe------------ -_-, _'___Material- --- ---------------------No. Compartments]---------------=------------� <br /> = Distance to nearest: Well--------=------•-- - _ ---_,Foundation----------------'------ Prop. !ine <br /> LEACHING LINE [ ] No. of LinesJ_ ----------------Length of each lirie---.- --.- - :------.Total Length.---:-- ------.--------------------ti-- <br /> 'D' Box------------Type Filter Material`---------------------Depth Filter Material-- { <br /> Distance to nearest).�A/.ell4 -------- E� .._._Foundation______ t"-------------!. Property Line_.______ _ <br /> SEEPAGE PIT p.. . .` ., . eter-:- ice. � --Number -�------ i-------- Rock Filed , Yes <br /> Water Table be th--------------------------- <br /> [ ] Depth ---- --'.Diameter-�-----�------- <br /> f Rock IS ----------s- ❑ <br /> 0 <br /> .} � p �. � � l -- -- I <br /> Distance to earest: Well-`------ ��4----- -----:Foundation---------------- ----_- Prop, Line---------------------------- <br /> i _REPAIR/ADDITION (Prey;Sanitation P,ermi #____. _ _- '�*"-�^-____ ----- .____.Date_._ .f )# <br /> t ;y t <br /> Septic Tank (Specify Requirements)--� . ---=- .- a _ -_ - -___ r, <br /> -- --- - - s -- <br /> ---- {--------------------------------- <br /> Disposal <br /> - - ----- ----- <br /> DIS OSaI Field (SFpecify RequireImentsl------� ' = 4 <br /> --'- ----------------- --- -----o---s----------- - ----------------- --- - -- ------- <br /> ------=- - -------- ------ <br /> ; <br /> (iDra xisting and requif—Feaddition on reverse side) <br /> I hereby certify hat.f have prepared-,this application and that the work will be done in accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules_ ; d RegufcsFtions of the [San Joaquin Local Health District, Home owner or licensed agents <br /> signature certifies the following: .—i ] � <br /> i <br /> "I certify that in the performance-of`the work for which'thWs�- mit�is issued, I shall not employ any perso d in such manner as <br /> s <br /> to become sub[ect to ork an`s. Com ene.iion laws of California." ',i; .. , <br /> a <br /> Signed ----- i-- +---- .. �f- r `Owner ..j, <br /> r � <br /> # --- {--------------------------------------------------- '` t .Title ---- --------------------=------=-------------=--------------- <br /> (if other than":owne') <br /> " } <br /> FOR DEPARTMENT USE ONLY. <br /> APPLICATION ACCEPTED: BY-- = -�---- - -- -- ------ -==---------= _------------------------==---'---DATE <br /> DIVISION OF LAND NUMBER: - - -----------------------------------------=------------------------- <br /> --- DATE <br /> ADDITIONAL COMMENTS-------------------------- - ------- <br /> ' --------------------------------------------------- R <br /> ---------- <br /> ---------------------------- ------------ ------ ---- <br /> i ----------------------------------------------- <br /> ---------- t ---------- ---- O --------------------------- ------ --- <br /> AN JOAQIIN CT ------------------------ --- <br /> Z Inspection by ------------=--------------- Date------ 7- -------------- <br /> EH <br /> --- ---`----EH 13 24 F&5 21677 REV. 7/76 37 <br />