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-•FOR OFFICE USE: ✓ FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. ...r ..� ... <br /> Dale Issued <br /> .......... This.. .. This Permit Expires 1 Year From Date Issued <br /> Appl+cotion 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 ADDRESS/LO,,CyA� TI N _ 'l.�04�. . S •/./[cC1� fj. _. _...CENSUS TRACT <br /> Owner's Name /4.FC LiN_ Q.1 JnC'Ite/�.. .. _ Phone . .... .... .. .. <br /> �y <br /> Address.. q''I5 r...!Q�= ' 4 le) /�,. ."NA City �.'f'_^�/C7Y'iJ Zip..9 <br /> Contractor's Name.. �V Plc f. �L1.yYy f✓tet; .License #. J''1' z Y.Z Y Phone. k?�.—�(.O�(..j <br /> Installation will serve: Residence ❑ Apartment House!] Commercial ❑ Trailer Court P_� <br /> Motel C] Other . . I.... ... . ..... ._. <br /> f /� <br /> Number of living units: .. .......Number of bedrooms. y Garbage Grinder../w.Lot Size...... f. :Jr i4-f'./�(f..J . <br /> Water Supply: Public System and name . . . ..... _. .._.............Private <br /> Character of soil to a depth of 3 feet: Sand p`�Silt 0 Clay j Peat❑ Sandy Loom p Clay Loom j ) <br /> Hardpan ❑ Adobe Lt Fill Material If yes,type.. ._ _... ...._ <br /> (Plot plan, showing size of lot, locction of system in relation to wells, buildings,etc. must be placed an reverse side.) 41 <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is ovoilchle within 200 feet,) <br /> PACKAGE TREATMENT I ) SEPTIC TANK I ) Size . . _._..._. Liquid Depth <br /> Capacity 1, 20(.' T ae '%"- <br /> yp Yn� c'4Material 0(1 Pia-Y-'f.:No. Compartmems....y2 .. . ,. . . <br /> Cistcnce to newest: Well .. .....S.0 . . _ . Foundation _. LlJG . Prop. Line.....�S ' - <br /> LEACH!N: LINE ! ] No. of Lines .� .. _.._ Length of each line .. S -. Total Length, I-7Qz .. <br /> 'D' Box Type Filter Material e C7('KDepth filter Material.! `9..... ......... / .... .. <br /> Distance to nearest: Well ..._(p S f . Foundation .Property Lire <br /> SEEPAGE PIT ' r - <br /> ) Depth .Z eS Dicmeter.,3.J . � Number yl-. _. . ... ny Rock Filled Yes L&- No <br /> Water Table Depth.... ../.(!J.C��.+. ... .....Rock Size.. �s7` <br /> Distance to nearest: Well. ._.�.J G .._..Foundation _ ,y vC' Prop Line. .. �Q <br /> PEPAIR/ADDITION (Prev. Sanitation Permit#.... ._ __..Dote`_.. ...... ._ ) <br /> Septic Tank (Specify Requirements) - .. .. . ...__ . .. .... .. ... . _.. <br /> Dispc i .field (Specify Requirements) - -. . ._. ._._ _.. . .. <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 Hearth District. Home owner or licensed agents <br /> signature certifies the .following: <br /> '•1 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 subject to Workman's Compensation laws of California." <br /> S. ned C /A` <br /> B.9 A..�. Itl C'�-�"• �A. OTirlee� l� b)7 �KCa.wL!•.0.{ <br /> pt other than owner) // <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION .ACCEPTED BY DATE ;i <br /> Di VISION OF LANs NUMBER DATE <br /> ADDITRJNAL COMMENTS <br /> Fmol Inspection by: - Dare <br /> " 13 %f <br /> SAN JOAQUIN LOCAL HEALTH DISIRICT rns 21677stv rr>n sM <br />