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s .4 <br /> FOR OFFICE USE: FOR OFFICE USE: It <br /> APPLICATION FOR SANITATION PERMIT <br /> ._........................................ <br /> (Complete in Triplicate) Permit No.79.�?1.�.� <br /> ..............................._............... <br /> :.... - <br /> Date Issued-3-.21::V <br /> _._.._....................................... ..... This Permit Expires I Year From Date Issued <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construe and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> yy y /� L <br /> JOB ADDRESS/LOCA/TION..... <br /> �tfv..4..: .............V... !¢f��.�iNE... 17:..--............... ............CENSUS TRACCT.................. <br /> y.-p..p.._...... <br /> Owner's Name....1..f..r�.E�/..._fl�.(.u.......... Phone.0..�'...I..Y.[..R........ <br /> . . n <br /> Address._.:. ..: ....... N. Lt,I�L.•.: d................... ........ f!!��.....l..G�!. ... ......Zip..�.S371;..-:..... <br /> Contractor's Nome....... ........._............................. _...................... ............._ . License�#. ......... ..............i.Phone..........................._:.... <br /> Installation will serve. ResiJ_^ce C] Apartment House Commercial Trailer Court ❑ - _t <br /> s. <br /> Motel ❑ Other...fJ' Fd/Eel..efi4.C...-........ <br /> Number of living units:...............Number of bedrooms............Garbage Grinder............Lot Size.......................................................... <br /> . ..r- <br /> Water Supply: Public System and name............e E ............................................................... ..................................__.Private:ate y.:y <br /> Character of soil to a depth o.`0 feet: Sand❑ Silf❑ Clay❑ Peat r] Sandy Loam❑ Cloy Loam <br /> Hardpan ❑ Adobe ❑ Fill Material.. .........If yes, type.... ......................._. { " <br /> Os6 g 'f <br /> ------------------------- <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings,etc, must be placed on reverse side.) « 'ys <br /> NEW-INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet) 1J1 <br /> PACKAGE TREATMENT ( J SEPTIC TANK [ 1 Size...................'.......................................Liquid Depth.... <br /> Capacity.....................Type......................Material................ I.......No. Compartments..............._.... x <br /> :.. Distance to nearest:WeIC:................._.....--...............Foundation..-.--..........-.........Prop. Line...................s..-. <br /> a <br /> LEACHING LINE ( J No. of Lines.............................Length of each line..............................Total Length .................... ... <br /> 'D' Box............Type Filter Material....................Depth Filter Material.._.................................................... ' <br /> - Distonc+to nearest:Well......... ::::i:- ,.-Founcotion............................Property Line............-.... <br /> SEEPAGE PIT I ] Depth Duame ar ..:..Number......................._....... Rock Filleo Yes❑ No C] <br /> - Water Table Depth... mom........_-........I....................Rock Size..................._........................_ <br /> .. . .�,� <br /> Distaric?1AAsareit:Well .... . . ......................Foundation..........................Prop. Line.......................... <br /> tEPA1R/ADDITION- pre nnetig9PQrmit#.........i..:. ---: .. Datec.::.---.......::.-:::..:^.:............I <br /> �„�.. <br /> tepNcTat�f(,Syecl :"iiemenisl.............................. ......_-...............-...--.....................--.-.....-........_.........................._ <br /> Disposal Field (Specify Requirements)..._.........._................................................ <br /> ........._.... ...:_..-.....--.__..._..... <br /> --------------- �7 <br /> ...............J. �.4c�,�/ ..-_ ......----... ... !.- ,✓c........._-_.............. <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 /> )rdinonces,. Stab Lows, and Rules'.and.Regulations of the San Joaquin Local.Heolth District. Home ownei-or licensed agents ; <br /> lgnuture cerM}ies the following: i <br /> -1 certify that in the pedwasonce of the work fol which this.permit ii issued, I.shall not employ any person in such manner, as <br /> a became subject to Workman's Compensatfon laws'of•Ca itcmf6." . <br /> r7gited_.... <br /> Sy_..— _.-.-......>.1.../... ! Owner <br /> . .................... ..................................../ .. ;•f` <br /> i <br /> - (if other than owner) ' <br /> as <br /> . <br /> FOR DEPARTMENT-USE-ONLY ......... ...... ....DATE...3.. 7�--�L................... �4 <br /> 1PPUCATION ACCEPTED BY..............A-.....�;iC.' �....._.._....... - <br /> )IVISION OF LAND NUMBER................................................. . <br /> UDDITIONALCOMMENTS..... ..-4 .................................................................................. S.. <br /> ...................................'--"-'---..............--......... ....--................. . <br /> -__••_............_..........................................._..............................................................--...................................................................... <br /> ..__........................................................ .... ..'.. ................ ... ........ ............................ <br /> inclInspection by:............................ �. �. n .--......................................Dom......3 ................ . <br /> 9 is zc SAN JOAQUIN LOCAL HEALTH DISTRICT fes asn W.vee sss <br /> I <br /> i <br />