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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. <br /> G. !..._7/.-33i- <br /> _ ----------- .. a <br /> ---- - ----.. <br /> ..._ .....---. _ ..---------- - --- <br /> ----- -- {Complete In*'dplicate) <br /> Date Issued <br /> This Permit Expires 1 Year From Date issued k herein <br /> and <br /> Application <br /> hereby <br /> o the offPermit tiinstall <br /> described. This applicationsade in compliance with Couflty-Ordinonce o549 and existing Rules and Regulations: <br /> 1�. 3. - - LIF tN}?'>e i J-C E -.....__------CENSUS TRACT _P-- <br /> . <br /> -.-l..C� <br /> JOB ADDRESS/LOCATION _. .__ <br /> Owner's Nome O <br /> SCF1 LO ------. �'-- <br /> Address ...-��-�-�.�_;._�---------LA.w.R EI�C.� '----..._.._city ----- ..-- -"----''---------- -'--- <br /> --_Ucense # --------- ----------- Phone ..._..- - <br /> CoMrador's Name .-._�?llll-t�(�-----------'-------- . <br /> Installation will'serve: Residence Apartment HouseO Commercial❑Trailer Court )] <br /> Jti F� Motel ❑Other .... ---- _ <br /> _� <br /> Number of living units:_f JJ.. Number of bedrooms Garbage Grinders Lot Size <br /> T „"'_".`_ Private , <br /> Water Supply: Public System and name - .. i_"_ . .-' i <br /> Charbcter of soil to a dgpth of 3 feet: Sand❑ Si Clay ❑ peat❑A/Sandy Loam ❑ Clay Loam { <br /> ,I Hardpan Ado}�e❑ Fill Material 409.. If yes type _­-1. -` - - - 1 <br /> (Plot pian, 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 seeps :t permitted'if icsewer is avatlab ithin 200 feet // <br /> ,) . <br /> PACKAGE TREATMENT ( I SEPTIC (Q.x .hTTANK•f�}' Size <br /> X . Li ,� Depth <br /> Ca c ty Jew (J EEO Material<�- CRF-x Fo Compartments f - <br /> . p .._ Type <br /> -Foundation - ----- Pro.line -• <br /> I <br /> istance to nearest: Well ..... ZZ -- 7(. <br /> Lepgth a{ enrfi line -- Total Length --- Q--� - <br /> LEACHING LINE [ No. of Lines ....Z I+ , <br /> • 'D' Box Type Filter Material .( ).©� � •Depth iter Material ._ �-- - : ` <br /> r--�- Foundation fQ "'( -._ Property Lina ._... ._..-...._ <br /> Distance to nearest; Well ...� --' <br /> I X f Number . t�'^r' Rock Filed Yes No <br /> SEEPAGE PIT [ Depth � Diameter' -- <br /> 1 -.RackSize��--- - - -.I. , r <br /> Water Table Depth ---- "'�F- .:--:-_.--.-:- , <br /> Line <br /> Distance to nearest: Well ... .0...-.. -,- <br /> -. Foundation . _.._.....-- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ._...,__y__' --�-_------------ Date ----) -. <br /> Septic Tank (Specify Requirements) --------------------------------'---------_- --- <br /> Disposal Field (Specify Requirementsi -------------_------------...----------------------------'----------------'----..--------- <br /> ..._._.__._....._ .. i <br /> --------------I-------- ...-- - - -'- - 4 ... ' `--- - <br /> (Draw existing and required addition Qn reverse side} !�, � , <br /> I hereby certify that 1 have prepared this application and that the work will be done in accotdar" with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of-the San Joaquin Local Health 011sind.hone owner or licen- <br /> sed agents s nature certifies the following: n In such manner <br /> W certify tir a rma of the work for which this permit is issued, I shall not emPEoy oi„+r parse <br /> as to bec sub) Wo s Compensation laws of California." ^ / <br /> Signed .e_ �. --------- --•---- Owner .. <br /> 81r.:. .....:....---------------. .......--------'-------.._....-----......--------�;: _ -.<_�._'_Title --..........-..-------•..:------- <br /> if other than owner) { <br /> FOR DEPARTMENT, USE ONLY <br /> DATE <br /> APPLICATION ACCEPTED BY ......_ -i- p'-, •---- -- - - - -•- - <br /> DATE <br /> _..- _. .... <br /> BUILDING PERMIT ISSUED <br /> ADDITIONAL COMMENTS - (� y \� <br /> �� � ---Date <.,.. ��. --...._.^�� _ <br /> le Final Inspecii§rr4a. • ._�.., 2 .. a <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E.H.9 1=68 Rev, 5M <br />