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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ----------------------- --------- -------- -- (Completr1eon Triplicate) Permit No.---- <br /> jj <br /> ---------- -------------- ----------- t <br /> \, Date Issued_.7`"_�:.c_.'. <br /> ---------_-------------------- This Permit Expires..1 Year From Date Issued <br /> t <br /> 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 Ordinate k No. 549 and existing Rules and Regulations: <br /> -- - -----------CENSUS TRACT.. •------------------------- <br /> JOB ADDRESS/LOCATION-._.: ----- ----J I-)--------- <br /> Owner's Name 3 - - e-- -- - - <br /> - - Phon - <br /> M .y �} ._1'_... - - ---------------------City- ---- ----------Zip----------------------- ---- <br /> Address.----- v��7� E ---, <br /> Contractor's Name ,,(1-c----- _JjR•W-'t:License #__c� 1 _ Phone <br /> 1 <br /> Installation will serve: Residence X Apartment House.[:] Com mercial ❑ Trailer Court ❑ f <br /> ' ;. . <br /> /'M'otel- ❑ Other____ <br /> Numbet of living�un.its;-_...,.1 _N.u�ta.ber of b room G_arbage Gri des'.. 'Lot Siza_, <br /> j am_ ------Private <br /> EE ' -- --- -- - 0 <br /> Water Apply: Public System'and name ._ i <br /> _ _ . ti t <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ ,Clay ❑ Peat❑IQ�5andy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe r'F%l Fill Material.-.. .......If ye§,_type___1 --------------------- � <br /> (Plot plan, showing size of t-, location�ofsyste`m in relation to wells, buildings, etc. nus be placed on reverse side.) V . <br /> E € f; <br /> NEW INSTALLATION: '(No"septic. tank -oi' seepage pit permitted if public sewer iF available within 200 feet,) r (1 <br /> PACKAGE TREATMENT—[ ) SEPTIG TANK Size- . -- s-- f��= --- Liquid Depth.-- ------------- <br /> -----� <br /> i <br /> < - Capacity/-2a�__6W_ _Type-f-.-- _ atwial---!�-�No.- Compartments---- -- - ----------------``- <br /> `� Foundation- � -'---- -=--Prop. Line---, ---------------- r <br /> D1stance;to.nearest..Wel1.. _-f2Z,1„ z_-----_--_-- <br /> P i : f <br /> LI=ACHING LINE: No, of Lines_:---__ .. -.Len `th,of each line.._- w- ngth -_, -- ---- <br /> - � Tot <br /> I 'D' Box '._Type Filter ater�al_�� p Depth f'.lterMater`I"`� _ ----- ---- - <br /> r �,, d <br /> _ <br /> Distanceto nearest.Wel1_,_ 1.; ounddtion. ._ .Property Line i <br /> ✓�/ F�. - } <br /> -. .• - Number___=_- Rock Filled -Yes No <br /> -------`----- <br /> SEEPAGE PIT j De th _--- <br /> piamet � <br /> � ---- --Rock Size._ c <br /> Water Table Qe th <br /> �,,w , me <br /> Disfdnce to nearesf:'WelL !� " ^� -- :Fou .datial,t1� ' Prop, Line__ <br /> { -- . <br /> AIR/'ADDITION (Prev.:5ar�itation Permit# - ----- [- <br /> REP' - -------- ---- <br /> ptic Tank (Specify Requirements)---- ..� ------ . �., i <br /> - ------------------- <br /> Dpsa; Field (Specify Requirements)_ __CG2 �-- ----- <br /> t ----- -- ------- -- - <br /> - ---- - ---- -- <br /> --------- <br /> Draw exiling and required addition'on reverse side) � <br /> if that:l have re ared this application and that the work will be done in accordance with San Joaquin 'County <br /> 1 he certify p p . PP <br /> Ordinances, State Laws, and Rules :and Regulations of the. San Joaquin Local Health District. Home owner or licensed agent <br /> signature certifies the folllowing <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall no+employ any person in such manner c <br /> to become subject.to Workman's. Compensation laws.of California." <br /> 3 <br /> C263 <br /> SEPTIC & SEWER SERVICE., J� <br /> Signed- ---- ------ -- ;-- --',,.. -- <br /> ------- _ -----_.--.----- Owner 263 50. Oro �t 'Stacicton,:Ca(if.. 95205 <br /> i,[,cfR. ------------'-------------=Title------:-----_P 463-32-0-9-_ £orttrar -s-Li '42S71 <br /> i (If other thanwner) <br /> F R`DEPARTMENT USE-ONLY' i <br /> i <br /> ` : --------- ,•►_•�- DATE.--- -- �'---- --- <br /> APPLICATION <br /> r . <br /> � <br /> ACCEPTED BY_,_ __.._ -------- - - ------- --------------------=--- DATE:: _ :.. . - <br /> Fi DIVIiSION OF LAND NUMBER:. ---- ----- ------------ ----- : ----------- <br /> 2_0( <br /> =-O(.... --�- © A. 1 <br /> ADDITIONAL COMMENTS ? ; <br /> ------------- <br /> ------------------ - ------------------------ ------------- <br /> --- - -- <br /> ---=------- ---`-----' ---------------------- ------- ---------------- ------------,---------__-- - _ ------ -------- --------- <br /> -- - - <br /> 4 - ------ - Date <br /> Final Inspection�b .� ..�---------- -- ---------- " ----- 7 - _ <br /> - -------------- - <br /> EH 13 24 AN JOAQUIN LOCAL HEALTH DISTRICT Fas 2�6n Rev. 7nr;inn <br />