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�s.w� •t'^='rt+1 F`Tt'l'i•� y'�ti`' .. �. 'i _ . . .. �" 0 yiw, � V <br /> FOR OFFICE USEr �Z FOR OFFICE USE <br /> (r APPLICATION FOR SANITATION PERMIT <br /> ........»............................................... 'Permit No.7e:e3. .. <br /> x <br /> (Complete in Triplicate) p p <br /> Date <br /> ..._........................... .............. .... This Permit Expires 1 Year From 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.. „Z <br /> This application is made in compliance with County Ordinance No.549 and existing Rules and Regulations: _ +^ <br /> JOB ADDRESS/LOCATION..........131.- ....h ... 4V..... ✓6:........................aNS S TR.6CT t <br /> Owner's Name.»_ ..... 9.9t✓u./'lu�Lb. ....................... 6�pnone �Y✓��� y-_ i <br /> _ ,� ei• <br /> Address.....f...J . PP <br /> 3. .r=�x9l..✓.K. o./.............................._.......... . . Gty L/'c?.t/YICe ._...._....Zip./ <br /> Contractor'sPC=GG..G"c .... License <br /> Installation will serve, Residence% Apartment House❑ Commercial❑ Trailer Court ❑ j - = mss{ <br /> Motel ❑ Other.............................................. t.2 <br /> -r Number of living units:....J........Number of bedrooms....�....Garbage Grinder............Lot Size...................................... ........... <br /> Water Supply: Public System and name.................................................»........... . ......................__..._..__..._............ . Pnvat <br /> e ❑ <br /> Character of soil to a depth of 3 feet: Sand C3Silt C3 Clay C3 , Peat❑ Sandy Loam❑ Clay Loom,aJ <br /> Hardpan❑ Adobe❑ Fill Material............If yes,type........ ............ ._. d <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 if public sewer�is available within 200 feet J <br /> :. PACKAGE TREATMENT [ ) SEPTIC TANK [ J Size...... Y.�J... / . .�.Liiquid Depth..a't,_y <br /> i v' OV oO( <br /> s ...._. ... <br /> Capacityf�........TypeR, Material...................._...No. Comao ents - •v^..;•.--- <br /> -: Distance to nearest:Well... .. ..'.............. .....Foundation..MP......... ..Prop <br /> Line... <br /> f, <br /> ,yy�� <br /> LEACHING LINE [ ] No. of Unes..�2......... ......Length of each line -,r!L'.'D.. .........Total.Length..'pLf. <br /> ..:. 1" _ _ <br /> 'D, Box Type Filter Material. �epihFilterMateri�al7...: ..yy.,.. rra .. <br /> - . Distance to nearest: Weil .........Foundation.... " --Property Li^ -• ... <br /> . SEEPAGE PIT I 1 Depth..._...._...Diameter ............Number........ ............. - Rock Filled Yes E] No���.:. <br /> . . . Water Table Depth - . r ...............................Rock Size <br /> Distance to nearest Well - ...::_................Foundation ...........Prop, Line <br /> k' ...........Data...... ... ... <br /> EPAIR/ADDITION prey:Sanitation.Permit B...... i7_._ ._........__». -•-•_• •-----••••••-- ' <br /> Septic Tank (Specify Requirements)...........................:._i......__..................._...........................».... .................... <br /> .....__..._.._.,..__._. <br /> f %Dispose) Field (Specify Requirements)..-».........._.•:-.:......_...................._..__....................._...._...._......._...._ <br /> mss.. - .............................._._.._......._................................._......................_............._.»_................. .'.... <br /> t <br /> (Draw existing and required addition on reverse sidel - <br /> ".1 hanbY caMfy that I have prepared this*application and that the work will be done in accordance with San ;u n '7'.nty <br /> a'[:Ordinances, State Laws, and Rules and,.Ragulations of the San Joaquin Local.Health Disn,ct, Home owner or licensed agents <br /> .sslgnatun ceoifles the following: <br /> r:�• cM@y that In the performance if,the work for which this permit is issued, I shall not employ any parson in such manner as <br /> ro become sub)ect orkm 'Compensation laws of California...alla. <br /> Signed,.. ...._� ..... _ .._...... Owner <br /> A., "By! Title........................._..._.................._...._......_......... <br /> ................»...__.........._.......................................... '... <br /> Y.:.....:............ _ <br /> ' <br /> [if other than owner) <br /> FQA DEPART ENT USE ONLY <br /> ._..DATE ._. ...--......_..... (�......:... <br /> APPUCATION ACCEPTED BY.. ...... ..... .. . .. ....-"-..................."""... <br /> .............._................DATE........ ............._..._................... <br /> DIVISION OF LAND NUMBER..............................................._...._..... 3 .. <br /> ..._......................................................................................................r_.._.._..__......... :e <br /> ADDITIONAL COMMENTS................... - _ - <br /> _ .._..__._... .........._...................__.........._......_....... <br /> _.._. ..............................._. <br /> .... ................_...................... ... <br /> ........................__.........»....»... ....�.�...... <br /> Daro .... ..�rL - <br /> Final Inspection by,............. ... .. .. . . - [:�.. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT res st�rtse <br /> w is x. - <br />