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FOR OFFICE USE: <br /> .. .............................. APPLICATION FOR SANITATION PERMIT <br /> " <br /> f Cantpfef eIn Tr#pikat <br /> is <br /> Permit Na. . <br /> hermieDateIssued <br /> •--.................fx iros Yoar frompaMfssed � 7-77 <br /> Application is hereby made to the San Joaquin local Health District for a permit to construct and install the work herein <br /> i escr <br /> dibed. This application is made in compliance with County.Ordinance No. 549 and.existing Rules and Regulations. <br /> OB ADDRESS/LOCATION <br /> . <br /> Owner's Name ._. .�.._. c�------•---•- <br /> . d .................. .....-CENSUS <br /> US TR <br /> ACT <br /> - ...................... <br /> j ._.. .. . v .. S:� 3. <br /> ..._.....-•---• ..-•,•"..............: :.:........... PhoneAddress ---- ----------- ----•------- <br /> CI <br /> ty <br /> _ ff <br /> Contractor's Name T Xr N -- - . <br /> - ........License <br /> Installation will serve: . ,�! ---••----...---•--...__. Phone -----•---___-- ,E <br /> Residence •"- """.... <br /> - t�►partment Hotise�] Commercial QTrarfer Court Q . <br /> Motel <br /> Q Other----------••----=--•--•-=-•-- <br /> Number of living _..--•-------•- <br /> units------------- Number of s .�...._ - <br /> Water Su rbage Grinder __....._.._. Lot Sizen.-- • <br /> Supply. Public System and name ?�' � T litf r - <br /> ..._. ° .�.... - -..... <br /> Character of soil toad Q -..-..�-...-••-•................Private - <br /> epth of 3 feet: Sand Silt Cfa� Q �,N <br /> E] Q y Q Peat Sandy Loa Q Clay Loam Q <br /> ' <br /> Hardpan p Adobe <br /> ' FII! ' <br /> Material ............. If Yes,type <br /> {plot'plan, showing size of lot, location of system In Islet#on to wells, buildings, etc. must be placed on reverse side. <br /> NEW INSTALLATION: (Na septic tank or seepage pit permitted If public sewer Is available-within 200 feet,) <br /> PACKAGE TREATMENT { ] SEPTIC TANK <br /> [ ] Srxe <br /> ................. Liquid Depth <br /> Capacity .:__...: = Type --------------------- Material.. ............... __ <br /> --.. No. Compartments <br /> -------------- <br /> ..... <br /> Distance. to nearest: well .... <br /> LEACHING(INE T _� -- oundation ...................... Prop. Line ......................... <br /> No. of Lines ,. <br /> Length of each 'line''...........2>- <br /> es <br /> Length <br /> D' Box __ __e.5___ Type Filter Material .:_I 4At <br /> _Depth Filter Material 'r <br /> Distance to nearest. Well ..:_:.. . Foundation <br /> - ----• ..�--..... Property <br /> Erne ....... 5 <br /> Depth . l - _. Diameter�� 1p� ............... <br /> ; ^ Rock ....•. <br /> � � -` . . Number .....:...._�.... R Filled Ye <br /> S` Water Table Depth <br /> U Rack 5rze <br /> No <br /> Distance to nearest: Well .................. <br /> Foundation __3...�.---. Prop. line• - <br /> REPAIR/ADDITION(Prev. Sanitation. Pe /f <br /> rmrt ._............-•-•----••..... .............. Date . <br /> Septic Tank (Specify Requirements) - <br /> Disposal Field (Sp�ci#y Requirements) •. . - ....................___--••• - <br /> ------•---•-- f ---- <br /> �� <br /> and re uired ---- <br /> - (Draw existin ...-------••-----•--•-------------------•..... <br /> g q tion on reverse side) <br /> ! hereby certify that i stave prepared this application-and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and .Regulations of the Son Joaquin Local Health District.,R <br /> sed agents,signature certifies lite fallowing: Rome owner or licen- <br /> sed <br /> "I certify that In the performance of the work for which this permit is Issued, i shall not employ <br /> as to beco u c any person in such manner <br /> Si ne / r a laws of California." <br /> d kman s- a e ti ` <br /> -------­---------- Owner <br /> BY ---------- ............ <br /> .. <br /> {If other than owner) - ' Title - • ------ <br /> . s <br /> FOR DEPARTMENT USE. ONLY <br /> BUCD NGION ACCEPTED BY_..__..... _ — - .. <br /> s •-•-•--------- = .. <br /> IsERMIT 1$SElED ._.- - • �Q„ .� <br /> -. . DATE,,_'/.-...�1.. .:__...1._ <br /> ADD( ZONAL CO ME 5 _...�-1/rte?_ --- - DA ,-------------------------- <br /> .. <br /> -- ,�,-� <br /> _-- --- .................... <br /> Final Inspection by: --•-•-----•---••---- ....................................--------- - a <br /> EI-# 13 2h 1-6#i � ------- -------••----.--•----•------- •--...................Date - ----V -•.�-- <br /> AN !O QUIN LOCAL HEALTH DISTRICT <br /> 8/7!I 3M <br />