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FOR OFFICE USE: FOR OFFICE USE- <br /> APPLICATION FOR SANITATION PERMIT �ia j,/ <br /> --------------------------------------- -- ----- L� l <br /> (Complete in Triplicate) <br /> Permit No.__'------�,'.-_-_.__-- <br /> ---------------------------------- -------- 7 <br /> Date Issuedll_._ -1 t <br /> --------------------___---------------------------------- This Permit Expires 1 Year From Date Issued <br /> Appricarron is nereby 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 nd existing Rules and Regulations: <br /> - ------ ----' - -- f R ---. ( (��D•?'�# <br /> JOB ADDRE5S/LOCATION..___. -___ � _____.._._GENS TRACT_._.____._._ , _ . _ ...... i <br /> Owner's Name-- _ - ------ - f <br /> Address L. ----�,�-----_.- .r- ---- ------------ City, <br /> yy p <br /> .. ._ _ ._ ------------ <br /> - L <br /> Contractor s Name.__.__ _ _fl _ ___. Z Y- <br /> �� - - License #v�_lh h Phone--�t�.�5.' <br /> "` , <br /> Installation will. serve: Residence Apartment House ❑ Commercial ❑ -Trailer Court. ❑ ] <br /> !Motel ❑ Other---- <br /> ----- ------------------------ <br /> Number <br /> ------- -----Number of living units:___."" Number of bedrooms_:__.=:Garbage Grinder__ .- -.-----Lot- -Size-Zl-__..40 <br /> .__.. -------------------- <br /> Water <br /> __._.._ #_._ <br /> Water Supply: Public System land name---- - _ ` . __ =.A.. _.__s- --Private <br /> to a depth of 3 feet: Sand ❑ Silt❑ :Clay ❑ ' Peat Sandy Loam ❑ Clay Loam El <br /> Character of soil o � � <br /> -Hardpan ❑ Adobe ❑ Fill Material-- --- -- -I Yes, type-------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings,,etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No, septic tank or see a e feed if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] -SEPTIC TANK Size __ - Liquid Depth ? __-____ _._f`" <br /> p, p.g pit sperms � <br /> Capacity.,�a0---_--Type��_ �"!1_=.Material_�L-�_.�----- --No. Compartments-"- _ ------------ <br /> Distance to.nea test: W II:,.:__ _..4 d„_______________________Foundation / ,6 -- --._ .Prop. Line <br /> LEACHING <br /> •S 8`'�- _ <br /> LINE No. of Lines -___,__..,__=„Length.of each line-------- :_-----__-- --_--,Total Length .._J` - <br /> D' Box-------. ;__Type Filter Material_;��r_-/?___/rDepth Filter Material-- <br /> Distance <br /> aterial-Distance to nearest: Well--- ,Q_ ______________Foundation_.,�a Property Line--S---- - `!' <br /> t i <br /> SEEPAGE PIT [ ] Depth `--- D_iameter. ------------------Number_________________ Rock Filled Yes ❑ Noy[ <br /> ------ <br /> Water Table•Depth-------------- -- -----------------------------------------Rock Size,,­:7F--------------------------`-----'- <br /> [ Disfiarice'to nearest. Well -----=----------------- ;Foundation- �'-=----------- -- Prop. Line . ----- <br /> REPAIR/ADDITION {Prev. Sanitation Permit#-=---------------------------------------------------Date-----------,----------------------_------------_] <br /> Septic Tank'(Specify Requirements)----- --- -- - - - ---------- -------- ------------------•----* <br /> DisposalField [Specify Requirements]----- ---------------- ------ ----=------------------------------------------------------------- ------------------------------ - ------------- - -' <br /> ---- ------- -- --------7 ----- �. <br /> ------------`--------------------------=----------------------------------------------- ---- ----------------------------------------- 1 <br /> (Draw existing and required addition on reverse side) x <br /> I hereby certify that'll have-Prepared this application -and that the `work will be done in accordance with San-;-,Joaquin County M� <br /> Ordinances, State Laws, and Rules and Regulations of the Sari Joaquin Local Health District. Home owner or licensed agents-4 <br /> signature certifies the following: <br /> "I certify that in the perfo-rmrance-bf the work for which this permit'is issued;;l'shall not-employ any person in such manner-as <br /> to beco eject to.W an's Compensation11.laws .of California." <br /> Signed-=._ ------ 0--"----- -- '--Q � _��f� <br /> = --'-- �----.. --------------_Owner <br /> , <br /> BY- _ .�.� Title ' ' <br /> -- <br /> (if other th owner] -" " ”" <br /> FQRZEARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- "`°` ---- ----------------------------------------DATE--------(-1 34 ---= - c <br /> DIVISfON OF LAND NUMBER - <br /> - DATE <br /> ADDITIONAL E <br /> COMMENTS__________________`. _ -:_ <br /> r <br /> ----------------------------------------- --------------------------------------------------- ----------------------------------'----------- ---------------------------- ------------------------------------ <br /> ---------------------------------• -- -------------- ---- -------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------- --------- ----= <br /> FinalInspection by:-----------------------------------------` ---.-------------'-----------------'------'_---`'- ---------- --------- Date.---�--� 7 16--=---------' -- <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 aEv. 7176 3M <br /> ” � A <br />