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i <br /> s <br /> OFFICE USE: <br /> �FO_„[2 <br /> ' A...r_ APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: <br /> ------ - �--------------------------- _ �" <br /> ---------------- <br /> (Complete in Triplicate) Permit No____________ __ <br /> --------------------- ---------------- --- ----------- e <br /> ,��7g_ <br /> ------------------ ------------------ ------------ This Permit Expires 1 Year From Date Issued Date Issued-7 <br /> t:� <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described ; <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations.- <br /> JOB <br /> egulations:JOB ADDRESS/LOCATIO ,, .aS " �N " ✓ ------------- <br /> _.CENSUS TRACT--------- <br /> ) <br /> Owner's Name--•---- a _ _ _ b-� <br /> 99.,2-- <br /> - ---- one_- <br /> ---- <br /> Address-_- --------- <br /> ------------------- <br /> ' = ----Ci <br /> f Contractor's Name---.-. �, - - _l t. _v1'- ' H '- —------__LicensePhone_ ,---- ..9,10 <br /> Installation williserve: ` Residence Apartment House ❑ Commercial E) ;Trailer Court,-❑ <br /> i <br /> t - ---- -- <br /> otel [ Other_--- <br /> Nu'mber of living units:__'_ .___Number of bedrooms.:__.3__Garbage Grinder_ Lot- Size_.�_,G ' {_ <br />'E Water Supply: Public System and name ------ -- --- - -- ------- ------ ---------- -- ----- --PrivateItIr <br /> ' - <br /> Character of soil to a depth`'of 3'feet,: Sand[] Y Si if❑s Clay ❑ Peat❑ Sandy Loam Clay Loam E- <br /> Hardpan ❑ Adobe ❑ Fill Material_- ------.--If yes, type_f_-----'�______________ /// <br /> n, showing size ofllot;location of system in relation to.wells,buildings,�etc'�inust be placed on reverse side.] <br /> NEW- STALLATION: -"4(No septic tank 'or seepage pit permitted if public sewer is availcib_le wifihin 200 feet,) <br /> PACKAGE TREATMENT i SEPTIC TANK; Size_________1�[�_Q "�' ` <br /> ----------- ------ <br /> � _ ------ -Liqui Dept ----------------- <br /> JA - -- <br /> Capacity` -�_C�`_Type/�/!�� ]`_Materials%YeGrt ,7r� No. Compartments__:___ <br /> ' <br /> --"Foundation-- r <br /> . Distance to nearest: Well __�_Q CJ__. _______" ' �� __,.__"""_ Prop. Lined <br /> �- <br /> LEACHING LINE [t] No, of Lines_- �" _.Length of each lirie---------7a-� v : Total Leri th _" I <br /> ------------------ <br /> D' Box--'-/-- _Type Filter Material.__I__�T------Depth Filter 145�s ... _ _ . <br /> Distance#o nearest: Well_ 5P -----Foundation _ _Property Line- _Q ---------- <br /> SEEPAGE <br /> ` I <br /> -- -- <br /> SEEPAGE PIT "[ ] t Depth. ._-__Diamete --------------- <br /> -------Number___-___ _ ; Rack Filled Yes ❑ No E] <br /> 1 Water Table-Depth 4--------------------------------------------------- Rock Size:--------- ----------=-------------------------- <br /> . Di§ta'nce.to nearest: Well"-_._.__-______,___ <br /> 7 - Foundation = ------------Prop. Line--- ---=_-------- <br /> REPAIR/ADDITION (Prev.rSonitation Permit#_k ':.__-__-_ ____"._"_:._ - Date__.- "-____-_----------------------- ] <br /> --------------- ---------- <br /> Septic Tank (Specify Requirements)-----------=------ <br /> '_ -------------------------- --------------------------- -------------------------------------------•---- <br /> P ( P Y q <br /> -------- ---- ----- - ---- ---= ---- ----- .-- 3 <br /> �s osa ie eci Re uirements _..__"_ <br /> zg - ------ ---------------: ------- - - -------------------------- <br /> __________________________________________ <br /> r ---_______e--------------_--------------------- <br /> ------------------------------------------- - . <br /> t t `{y `(Drawexisti=g and required addition on reverse.side) <br /> I hereby certify that I have prepgred.this application and that the wok will be done in accordanwwith 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�i's ssued, I shall not employ any person in such manner as t <br /> to become ct to Workman's Compensation .laws hof California." Y t <br /> Signed = % a-: s em. = ------------_Owner <br /> == = <br /> )'Title-- - .- <br /> (If'other than owner),,. r , <br /> 'FOR DE RTMENT USE ONLY: } <br /> APPLICATION ACCEPTED BY: - -__ .__ ______-_ --_ -_•"_" ' - . D--7 <br /> - - - - = ----DA <br /> DIVISION OF LAND NUMBER = �'j t . ------------- -------- <br /> aDATE -- ----------------------- -I <br /> .,ADDITIONAL COMMENTS f-- -----_w-- -- --__ I <br /> - -- ------ -- - ------ - ---- -- -- -----. <br /> +� J;-*w �'�'-' - <br /> 1 � ;f --------------- <br /> --------------------------------_ <br /> I". 4 <br /> •------- r <br /> t <br /> ---------------------------------------- <br /> Final Ins ection•b ---_W <br /> - - - ---- --- �." - <br /> eN 13 24 SAN JO UIN LOCAL HEALTH DISTRICT F&s 23677 RE)Ij7p(76 3M <br />