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FOR OFFICE USE: ' - k FOR OFFICE USE: e j
<br /> APPLICATION-FOR.SANITATION PERMIT
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<br /> ............. (Complete in Implicate) Permit No._7.7r._5.11
<br /> 6-,.2 3- ?
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<br /> Date Issued....................
<br /> -------------------------------•---------------..._-_.v This Permit Expires 1 Year From Date Issued
<br /> Application is hereby made-to thef'Sian.Joaquin oca a��t_Y�for a"rmit TO-00A and install the work herein described.
<br /> This application is made i compliance with County Or fr3tlrac,-_�&,549 a4d'ekt}Engritules and Regulations:
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<br /> JOB ADDRESS/LOCATION....- .--- �._:-.,, __-,_.,_�:: - 1_�J--/Lr�.--/�Q ----�J-----------------...CENSUS TRACT._.-.._.......------s__..
<br /> C>wner s Name.:... ` � `•���._.- T:......- ` :Phone
<br /> ... � ... _ . - --
<br /> Address--•-• lls�ir �=....... , ---= ---......................:Citi'---_Ze'Gt - - --- --ZIP----
<br /> Contractor's Name..... - _-_t.=.................... . _- Af
<br /> ��./ .........--•- - i License Phone-.- �1 AA
<br /> ' _ f7
<br /> Insta)lation,will serve: Residence.X Apartment House Commercial ❑ ;Trailer Court ❑ )
<br /> ..; Motel 0 Other--------------=.................................
<br /> Number of living units.___[,:......Number.of bedrooms...__.Garbdge Grinderjo*�Z.....Lot:Size...-L-?2"�Ls�-`�... ..... ----------
<br /> alter Supply: Public System and.&16------------------•--.,...:;_.....----.'.....:.-•--- .... •
<br /> # fir`--:-;:r---------- ----_:_::Private'
<br /> Charccder of soil to a depth of 3 feet: Sand r] Silt❑ Clay❑ Peat❑�, Sandys am< CfayrLoam ❑
<br /> � �1' i ------------ �
<br /> G E] Adobe E] Fill Material.._. .
<br /> Hardpan __ ..If yes,;type ..
<br /> . �_ ____
<br /> (Plot pl6n, showing-size of lot, location of system in relation to wells,building's,fetc.61-u-sl be placed og*reverseside.) i
<br /> NEW INSTALLATION:' No septic'tonk or seepdge 'itpermitted if pub[it sewer isG bilable with'A200 feet,] }
<br /> PACKAGE TREATMENT [ ] SEPTIC TANK : "'-,' - E I
<br /> �.. i I E) Size Fi���i0 = •- - ` --_-;._Liquid Depth-- ------•----••----
<br /> I I r ;
<br /> . ' __--11 fes , ,�,
<br /> CapacityQ�__.._yType +_CAF#l:.Material _ /!iC ', o. Com artments ..____
<br /> �. s �, ,..............
<br /> . .:
<br /> Distance to.nearest• We11.,_.....:��.__ �Foundohon_ 4_.., _..____ 1 ?
<br /> � i . _..,..-•--------------•� .,Prop. Line.---�f_._------.._.
<br /> of ! ._._._:_;__ .Length of eac-h hria._ f
<br /> LEACHING LINE [ 1. Do Box�I I s------T Filteateriay' iE�_.. @ep s ata[ Lngth....._,
<br /> I _ _ti ! e� ---------------
<br /> th Filter Mate al-��..��
<br /> :�.......... „�•,,, D ._ .. -,o►.,.e. � �•'- r
<br /> --- ------------ ---- •---
<br /> o -•.
<br /> 4B T � ... h....< ;....B aaeter.f. - *'.F....- -- �� s.__Property Line_.........
<br /> I istance tnearest:Well ,_.......
<br /> ..._._..Foundation.__:
<br /> o I ❑ ❑
<br /> yrarer ;v.�'!:�r th -.Rack Si N °,
<br /> Rock Filled "Yes
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<br /> 'Distance to nearest: Well....:'._:_.::" -. ;_......Founda#idea:_h..
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<br /> Pro
<br /> r __________________
<br /> REPAIR/ADDITION (Prev..(PrevSanitation Permit _ Dates... "•"'~+, �Ly_w L,.
<br /> Septic Tank(Specify Requirements).--_t--__.`.._ - ?'• ... ----------- ,. s=:
<br /> = :...:
<br /> I Disposal Field (Specify Requirements)------------- -__.__♦i
<br /> --------------------- ----------------------- ---
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<br /> ---_ --------------------------------
<br /> --------------- -------------- -------------------------- --------------------------------
<br /> (Draw existing and required addition`on ri:v9F'se side)
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<br /> I hereby certify that I have prepcired this application and that the work- will be done in accordance with San Joaquin County
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<br /> 'Ordinances, State Laws, and Rules and Regulations of the.San Joaquin Local Health District, Home owner or licensed agents
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<br /> -signature certifies the following: `
<br /> ( "I certifytha in'the performance' 'ofahe work for which this permit is.issued, I shall not employ any person In'tuch manner as
<br /> to becomes b=eef to m n's mpenfation;,lawa,.of California.'.' s ,
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<br /> Signed. _
<br /> B _ r
<br /> Y a:
<br /> -Title .. .._
<br /> (If other than'bvti rief) +
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<br /> ' -FOYREPARTMENT USE ONLY' 4'
<br /> APPLICATION ACCEPTED BY...........
<br /> .. ..r..:_ a• -_......................... =..............:------=---DATE..4 .Xr__zrT -:---=--{
<br /> DIVISION OF LAND NUMBER...................... __:w, _:.:..........:........�,w ............ ...DATE._....
<br /> ADDITIONAL COMMENTS :....., --•-•-•......----•............. •----------••---
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<br /> i = ------------ ---------------------------------------------
<br /> ------------ --- _ ----------•-- +
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<br /> ...a.
<br /> ;... -
<br /> `ts
<br /> Final Inspection bY_45:_::--.-- =_ s - -----• --- -Date..
<br /> ' ' en 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fos 21677 xcv:`(rd 9M
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