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FOR OFFICE USE: FOR OFFICE USE: <br /> V"�APPLICATION FOR SANITATION PERMIT <br /> ------------------------ -------- ---------------------- Permit No.�y_-/O $ <br /> (Complete in Triplicate) -----/--- <br /> ................._____..__._......... . --------- This Permit Expires 1 Year From Date Issued Rate <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 Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION---------' ------------------------- -----------itf`--Da A/ ------------- CENSUS TRACT.--------- <br /> Owner's Name-- _ ------------Phone_ <br /> -------- ---- Al----- ------------------------------------ ------------- <br /> /00 TT <br /> Address--- y / 10>1 G_C . _.f ------------ -- h1 / <br /> - ------------City------------ - -- - --------------ziP------------------------------ <br /> Contractor's Name-____ . .�..._� �`�(I. so� <br /> -- - -- ---- -- -- -------------------- L7cense r5 -- ----Phonons_"e.:7vG67 -� <br /> Installation will serve: Residence ❑ Apartment House ❑ Comrriercial ❑ Trailer Court ❑ <br /> Motel ❑ Other---- --- -------------- <br /> Number of living units:-_.1..-_._....Number of bedrooms__ .__.Garbage Grinder!-__.__._.Lot Size__-_l .-- --------m_ __ <br /> Water Supply: Public System and name----------------- -- - t <br /> --- --------------- --- ---- ----'----------------------------- ------------------- ------------------Private <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat [] I Sandy Loam ® Clay loam F-1Hardpan [-] Adobe❑ Fill Material______------If yes,xtype-------------------------------- <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 seepage-pit permitted�fk, blit seer is available within 200 feet,) Ji <br /> PACKAGE TREATMENT [.>]` SEPTIC TANK [ ] Siz-eE-_- _16,,964���----------- -------Liquid Depth---5-Ir-------------- <br /> � <br /> NJ <br /> Capacity (1'-�T Type. e4�Material--------------------------No. Compartments--- ---- ------------------- - <br /> Ir <br /> Distance to nearest: Well------ ._----------------------------Found _ _ation. . f Pro _Line., 1 <br /> LEACHING LINE; [ ] Nb, of Lines--%3---------------------Length of each line__ ..-_...._. g <br /> ----.Total Length -----OP-G* -------------------- <br /> f / <br /> `D' Box- Type Filter Materidl.l�.��_J4epth Filter Material___!----.__.._..__.____._.._.._------------------------- <br /> Distance to nearest. Wellj.rl.'_�_------__...._...Foundation-__/_h---1-------------Property Line....� _______________________ <br /> SEEPAGE PIT [ ] Depth__-------------Diameter.-------------------Number-------------------------------- Rock Filled Yes ❑ No ❑ <br /> WaterTable Depth----------------------------------------------------,Rock Size----- ----------------------------------------- <br /> Distance to nearest; Well.....................................r_/__Foundation----_---------------------Prop. Line.__-----.-----------___..___ <br /> f <br /> REPAIR/ADDITION [Prev. Sanitati6Fi Permit#...` ._...= -._.---_....__ __.Date.............. ) <br /> Septic Tank {Specify Requirements)_--- �, ------------ <br /> Disposal Field (Specify Requirements}_--__.-......._. ..__.____f....-.._ d <br /> E. ----- ------------------------------------------------- ------ --------- <br /> _____________----.._------_____---------- <br /> -------------- • <br /> - t --------- ---------f_-----.......'.------'--"-----;.._...-..-....-....-------------..----------__.--._...------- --------------- <br /> �t r {Draw=existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance .with San Joaquin County <br /> Ordinances, State Lowscrnd`Rules LandRe <br /> ' gulations of the San Joaquin Local Health District. Homeowner or licensed agents <br /> signature certifies the foliowing, `' , T <br /> "I certify, hat in the pe rmance of the,woik for whith this permit is issued, l $hall not employ any person in such manner as <br /> to beconite sub'ect t o n's Co nsation laws of California." <br /> Signed - ^i Owner f <br /> , .. <br /> BY--------=- ------- ,-- ---- 4--------- --------------------------Title---------------- --------------;------------------------------------------ <br /> F (If other than owner)It <br /> FPR DEPARTMENT USE ONLY- t <br /> APPLICATION ACCEPTED BY-.----- DATE. Z r7 <br /> _ _ _ _ DATE------------ <br /> AL <br /> ' <br /> DIVISION OF LAND NUMBER ------- - - - -----,.- ,.. - -.'----:- ----- -------------- `-- -----------.----.-- <br /> ADDITIONAL COMMENTS---------- - - /V P __ '�it7c> 7��� d ,-� D <br /> ---------------- -- I-� ------ --AlrUx,--- -------------- <br /> ------------ --/-- --------------- ----------------------------------------------------------- <br /> ------------------------------------------------- ---- ---------------- --------- -------- - --- { ------j ----------------------------------------------- <br /> ------------------------------------------- ---- ----- <br /> Final Inspection b --------------------- Date f � ---------- ---- <br /> P- Y:---- --------------- <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV, 3M <br />