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FOR OFFICE USE: <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMi - <br /> z F <br /> - <br /> (Complete in Triplicate) Permit No....................... <br /> -----••------------•------- 7� <br /> .......... <br /> .............................-...... ................. This permit Expires 1 Year From bate Issued Date Issued......... <br /> }Application is hereby made to.the San Joaquin Local Health District for a permit to construct and install the work herein described• <br /> his application-is made in compliance with County Ordinance No, 549 and existing Rules and Regulations: <br /> -.OB ADDRESS/LOCATION..... � ...----- 1�.� rl..G.f 1----...----•-- ............................---------- <br /> .............•- -•--••-----------.CENSUS TRACT.................. <br /> wner's Name ....-...�..t�'. ------- <� ----------- ---- .... <br /> • ......... •---Phone.�7�f`n. ..7.. ..- <br /> a� �j ... <br /> kddress...cII�S^I._. :.. 11 �l .t .. --�-�---- - .r----- <br /> .-Zip.....-•---•-....:......_. --- <br /> -- T <br /> Contractor's Name------.- ----- ( . ..... l.P..-.l..... �� <br /> 0 0 `� . ...............License #-..-.. . ....Phone --l+o-S--- !/ <br /> f'hstallation will serve: Residence Apartment House ❑ Commercial C] Trailer Court El <br /> E= Motel ❑ Other- ...........................:. ..... <br /> Number of living units..._--.........Number of bedrooms-.,3.....Garbage Grinder.-..-..-.-Lot Size.------. ._..{ 1/y.._......-... <br /> Vater Supply: Public System and name.................................. .. . ... -----------------:------:-Private a] <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> r Hardpan i? Adobe ❑ Fill Material - .-.. ....If yes, type--_-------------------- <br /> ,_?lot 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 if public sewer is available within 200 feet,) r C� <br /> `ACKAGE TREATMENT [ ] SEPTIC TANK fq-' Size ..�f.�r 1 .. x.91, .------------------ Liquid Depth.::.......----------C� <br /> Capacity.1xl..� ---.---Type-_ - -` ?....Material-. a ...-.....:No. Compartments........:-.+---.-. L�.-.-.-.- <br /> .Distance to nearest: Well....... -------- - -------Foundation. h .......... Prop. Line..5- <br /> ' -°. . <br /> EACHING LINE [ No. of Lines ..-:- -- -------------Length of each line.--- ..- -------- Total Length .. .... 7 - ............... <br /> r� tle <br /> D' Box..........._Type Filter Material.; A-t-4...Depth.Filter Material........./..0.... <br /> Distance to nearest: Well_..0-?VP..- . �.- <br /> c5 .. <br /> ...Foundation Property Line... - S <br /> -5EEPAGE PIT <br /> [ 'Depth---...:5...._Diameter----- ....Number_..----�:;Z................... rr Rock Filled Yes ' No ❑ <br /> Water Table Depth------ -------------------- =---.-Rock Size---- ..1.....---- :.._........- <br /> Distance to nearest: Well.---------- 14.Q.....................Foundation--- <br /> �lCj..a..........Prop. Line......5.44e <br /> REPAIR/ADDITION (Prev. Sanitation Permit#------------------------------ --- ...............Date.........................................-..... <br /> } <br /> F <br /> eptic Tank (Specify Requirements)...... ................. <br /> ...................i-------......••---------- ... . ....... <br /> Disposal Field (Specify Requirements)...:-. --------------- -• --•• ------------ ----------------*------------------------- <br /> h ---------------------------------------- <br /> --------------.---------.---------------------------....,.._........ ----------.------------------".-------------..-.----------.-------------­-­------- __-_..-. - -----.-------------------- <br /> (Draw existing and required addition on reverse side) <br /> [-' hereby certify that I have prepared this application and that the work 'will be done in accordance with San Joaquin County <br /> 1 )rdinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents <br /> signature certifies the following: <br /> FI certify that in the performance of the work for which this p-ermit is°lssued, I shall not employ any person in such manner as <br /> o becom biect to Workma Compensation laws of California." <br /> Signed.-.- .`::_. <br /> -��' �- --- - ----------------- - - Owner <br /> F3Y IrLC..L<r ------ - Title.. r----------------- ---- - <br /> (if other than owner) <br /> OR DEp RTMENT USE ONLY <br /> F7NPPILI�tTION ACCEPTED BY-.... ------ --- DATE � � ......'.'SON OF LAND NUMBER.--------- ........ ...----- DATE.... -----------"-. ^..................---- .... <br /> rDDITIONAL COMMENTS....------ -- <br /> -------•--------------------•------------------------- <br /> 4. 2 <br /> ..............-............. ............ ... ........... ... ........ <br /> -------------------...------------------ ` <br /> inal Inspection by:........� -----..-Date. _ <br /> .�2... <br /> F-..-,H 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 2387/- 7/76 7M <br />