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- ...... <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) - Permit No. .7.... .!6 3 <br /> --- ----------- <br /> ....................................................... This Permit Expires 1 Year From Dote Issued <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein <br /> described. This application is made in compliance withCountyCo_untty Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOrATION l��S.S�p. F`L ie- ------- .....CENSUS.....CENSUS TRACT ............. ........ <br /> .... <br /> Owner's Name -- --e22y eQfi . .� ----- - - -- .... - .........-. <br /> - one ............._..-............---... <br /> r P <br /> Address . . .r 0...... c. city <br /> ........... ..... <br /> Q <br /> '. --- <br /> Contractor's Name ._0149 +1p.. �.C:�' -----•- _--.-•-•License 3't5 -_ Phone 2 <br /> Installation will serve: Residence❑Apartment <br /> House Commercial OTrailer Court O <br /> MoteOther ..kLP s.-Pte..-.. . _ <br /> Number of living units:............ Number o bedrooms v.2.......Garbage Grinder ....... .... <br /> Lot Size --- `•...........1.1 , <br /> Water Supply: Public System and name ........---.....................................--•-•-• --------------- ...........................Private \) <br /> Character of soil too depth of 3 feet: Sand j] Silt❑ Clay O Peat❑ Sandy Loam ❑ day Loam 0 \. <br /> Hardpan Adobe Fill Material If yes,type............... ............ � <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,) / <br /> i <br /> PACKAGE TREATMENT I ) SEPTIC TANK Size...../ .Q........................... Liquid Depth .`�..x--............ <br /> Capacity -42-.v..p...... Type Material...................... No. Compartments -- --------: <br /> Distance to nearest: Well Well' ... lc 8......................Foundation../91............. Prop. Line ....._......--_.... <br /> LEACHING LINE p(J No. of Lines . .......C............ Length of each line........y ......... Total Length ... ............. <br /> rr iJ <br /> 'D' Box ...I...... Type Filter Material .J.y ...Depth Filter Material .....4� ...................... ... <br /> Distance to nearest: Well -425V-...... Foundation .............. Property Line ........................ <br /> - SEEPAGE PIT Depth - .. Diameter ` 3jNumber .......2 ......... Rock Filled Yes)d No <br /> Water Table Depth ....�?2-.............................R9ckSize .................. <br /> Distance to nearest: WellZ.C.Z...............................Foundation .................... Prop. Line ........._........... <br /> � <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..-......-------------------------I [1 <br /> Septic Tank (Specify Requirements) .... .............. -••-•---....__............................ ...............................................I.................. <br /> ...-... <br /> Disposal Field (Specify Requirements) -------------------------------------------------------............----............_......--.....................---..... ....... <br /> 1 <br /> ..............-...........................................................................................................-.........-................................ .................... <br /> .... ...... --........... ................... ----- ... .......... .......................................-..............--------------- ----.....................• .. .........................-.-. <br /> (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 <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Ilcen• <br /> ted agents sig un certifies the following: <br /> "I certify that i he performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become t Xn'!pensati laws of California." <br /> Btgned ... :.... • - - . .. -v Owner <br /> By - .... ... .. . ..............- TitleC......._...... <br /> (If other than owner) <br /> _ FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .. ----- DATE l.c.-" t ..-�.�-...__-.., <br /> _.......... ...._... - ...................-... - - -- <br /> BUILDINGPERMIT ISSUED ........................................................................................_...._.......-_DATE ... ...-.........-.. ................ <br /> ADDITIONALCOMMENTS ---. _.... -.. .............._....-.--......._.........-..................... -- ......................_.-............................. <br /> ......................-........_-._............... .................-.-..................................-....................................... .......... .. ........................ <br /> . . ........... I . .. ........... .......... .... . .......... ...-.. .... .. <br /> ....... . ... ............. .... <br /> F , Y.: .................. ....... ....................... - S <br /> R l ........... <br /> inalInspectionby: . e-- � . ................................ .................I..... ......Iae . . . ........... <br /> EH 13 24 1-68 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT $I7h 3M <br />