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FOR OFFICE USE: FOR OFFICE USE: <br /> �APPLICATION FOR SANITATION PERMIT S y, <br /> ---------- _ - <br /> - �----- (Complete in Triplicate) Permit No.7 .__ __---.--. <br /> -------------..--------'---------------------------- -- <br /> Date Issued--6_� '" <br /> ----- ------ <br /> .-- This Permit Expires 1 Year From Date Issued n <br /> Application is hereby made to the San Joaquin Local Health Disstoct,for a permit to construct and.i tc�I�th or! opci cribed. <br /> This application is made in compliance with County Ordinance No.5449 and eeexxisttiing Rules an/diteg laiiiwsf VVV <br /> JOB ADDRESS/LC)C;A�TIQ]N +7 7 X-------�' leowe 7- -;. _KGY---.-�C�,/UeENSUS TRACT. <br /> J----9p�----------------- <br /> ---------------- <br /> ----------------- <br /> Owner's Name_7"1--c�(J -+-�- --- _---- - ------ - ----- ,��---j-- Phone_p.3Pn"Z-,53 --- <br /> Address.jZ7047, � �_ Y� - -J I�/ / --- -ri City �WN - ----Zip.p`r�7/ Q --. <br /> Contractor's Name. -_----: � ? ��-( :./.VO�/1L'emj49� License #_-_--- <br /> ------- <br /> _ n_ <br /> Installation will serve: Residenceo A4 artment Hous€❑ CoVnmer��iiif�I C) Trailer Court ❑ <br /> MoteOther--.7Y1O►3� ----J*QM--� <br /> Motel <br /> Number of living units:__/---------- umber of bedrooms , -)_ Garbage Gr,]nder_N- -Lot Size _.- ;#4_� _-- <br /> Water Supply:-PubliCBystem and name...-....__.. -.... ---.1.--- ---------------------- -- Miivate ly <br /> Character of soil to a depth of 3 feet: Sand Silt a Clay [ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe [_] , FilMateric(I _,._- If yes, type -..----.. ----------- -- <br /> plan, showing size of tot�,J«ation of sy$tem in relation to wells buildings, etc.must be pl ced-dtv*leri "cle.) ` <br /> W_INSTALLATION- 'jNo septic tariror seepage pit permitted if public sewer is available within 200 feet,) m <br /> PACKAGE TREATMENT [ j SEPTIC TANK ] w�vSize _ :0� Liguid Depth , �P <br /> Capacity-- -Z --f-Type J. Naterial --- Wo Jfonforffnel't 1n <br /> - Distance toneare3teWell -- ---�f l ._,-- -_r,--Foundafwn.: y------------ Prop. cline _.�- _. <br /> LEACHING LINE [ ] No. of Lines. / -- _------Length of each Im i Y7� YbtaJ�engtlh <br /> H r <br /> 'D' Box -1-- —.-- -­ <br /> _ _. - _ t�i <br /> �s}{yyt�S Distance to nearest: Well r --_.-Fow dation 4._ property Line.. f;i__. <br /> ](�� Z a <br /> Sl �t"PtT [ 1 bepth.[-6-_ ,(/4 .S/If76 Number-----------------------..- / Rock Filled j�leSX No <br /> Water Table L"depth--------------------------�------------------ ---Rock Size---1-�=:eC f[-Q- L � <br /> Distance to nearest: Well--...o ----------- .-_----------Foundation-_1 ------------------Prop.. e---_ <br /> REPAIR/ADDITION (Prev. Sanitation Permit#__---_- -------------------------------------Date--------------------- -__--------- --- -----) a <br /> SepticTank (Specify Requirements)........------------------- ---------- ----------.-----------.-------------------------------------------------------- <br /> Disposal Field (Specify Requirements)-- -- -- ----------- ---------------- <br /> - <br /> _.l <br /> ------------------------------------_. ..__-...-------------------------------------------------------------------------------- <br /> ------------ <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 County, <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: <br /> "I certify that in the performance,of the work for which this permit is issued, I shall not employ any person in such manner as <br /> to become sub'e t' to rk aan' Com ensation laws of California." (� <br /> Signedc�.. '0 ---- ---- ---- ---- - ---------Owner <br /> By- . --------------------------------------------- - - - - Title <br /> (If other than owner) <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED _Y <br /> BY.-. -- -- - _DATE --_l9 - ZZ-17-7 <br /> -- ------ - <br /> - ... <br /> DIVISION OF LAND NUMBER - -- -------------------------------------------------------- ----------------DATE.--------- - ---- <br /> ADDITIONALCOMMENTS-- ---- - ---- --------- ------- ------------------._.-.---------------- -- ---------------------- ----------------------- <br /> - <br /> ----------------------------------------------------- ---------- -- ------ <br /> - - - - ` ---- <br /> ---- ------------------------ <br /> - ------ ---- -- - - --- ----- ---------------------- <br /> Final Inspection by:... ---------------------- <br /> a <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F85 416T7 REV.]/7ti 3M <br />