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> y �-Ss ~R OFFICE USE: <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMITFOR <br /> ----------------------- -------------------------------- Caeibe�nplicate) Permit No.�,��_L7 <br /> - <br /> ------------------ ------------------------------------- , F=00 <br /> ® �� r Date Issued_��`__,�� <br /> •-------------------------------------------------------- This Permit Expires 1 Year From Date Issued <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 ADDRESS/LOCATION--_- -- C4Jl��Z-------------- ----- - ,._P1,VQ9,C0WES TRACT--------------------------------- <br /> Owner's Name - .T'Ve ----- - of Sc------------------------------ -------------- ---------------------- <br /> ------------------Phone----------------- ------------------- <br /> ------- <br /> Address_ ..----------- ------------------------------------ - ----------------------------------City--------------------- -------------------------ZiP--------------- ----------- <br /> 2C <br /> Contractor's Name ' )g(_-_(_(_e------------------- -------------------------------------------------------License -----Phone---�6-2 _7'6�_S�_-. <br /> Installation will serve: Residence[1f Apartment House.❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other. _-.. ________________ <br /> ` <br /> Number of living units:-__j_____-___Number of bedrooms__2___ __ _ <br /> _Garbage Grinder _____ _Lot Size____ ______________________________-.._____________ <br /> Water Supply: Public System and name---.-.R\e.z_CLU6 ` ___________________Private ❑ <br /> ---------------------------------------------------------------------------------- <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam �d Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material_---------If yes, type____---__-._-.__--____.__._.. <br /> (Plot plan, 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 seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK ( ] Size-----------------------------------------------------------Liquid Depth-----.._________________ <br /> Capacity---------------------Type----------------------Material--------------------------No. Compartments--------- ---------------------- <br /> Distance to nearest: Well---------------------_---------------------Foundation--------------------------Prop. Line________-_---..._______.__. <br /> LEACHING LINE [ ] No. of Lines-----------------------------Length of each line. ..Total Length.________---_-...______-_-..___-____-..- <br /> 'D' Box------------Type Filter Material ___________-------Depth Filter Material------------------------------------------------._ --L. <br /> Distance to nearest: Well---------_------------------Foundation----------------------------Property Line____________-___-.._---___ <br /> SEEPAGE PIT [ ] Depth----------------Diameter--------------------Number---_---------------------------- Rock Filled Yes ❑ No ❑ <br /> WaterTable Depth-------------------------------------------------------- Rock Size---- ------------------------------------------- <br /> Distance to nearest: Well------------------------------------ ------Foundation--------------------------Prop. Line_..--_-.-_-____-._.._-___. <br /> REPAIR/ADDITION (Prev. Sanitation Permit#_..-..________-.-___-.___---._______-._---_.Date______________________ -__-__) <br /> Septic Tank (Specify Requirement qQ u�,e:>_C..V��_._ 6 L R& ----------- [ <br /> Disposal Field (Specify Requirem§nts)- _:3+ �--'"-a--t---------------------------------•------- ------------- � `--------------------------------------------- `C <br /> --------- ---------------------------- ------ --------------------------------------------------------- <br /> ------------------------------------ j <br /> r <br /> ------------------------------------------------=----------------------------- - --- ---------------------- --------------------------------- <br /> (Draw existing and requii�ed-addit oo ry,on reverse side) <br /> 1 hereby certify that I have prg4clred this application and that the work wilt be done in a I cordance with San Joaquin County <br /> Ordinances, State Laws, and',Riles and Regulations of the San Joaquin Local Heals Di strict, Home owner or licensed agent <br /> signature certifies the following: <br /> "I certify that in the performan of the work for which this permit is issued, I shall riot employ any person In such manner as <br /> to become subject to Workmp.n <br /> Signed --- ------ Owner x=� <br /> BY V----- -----R. -- <br /> T`►tle <br /> (If other th -------------------------------- <br /> 4_T . .. _ i <br /> - r - T -- <br /> \4 f�R "PAOMENx ~' NL�Y ` <br /> APPLICATION ACCEPTED BY ------ - ----DAJE------ - <br /> DIVISION OF LAND.NUMBER-------------------- <br /> ----------------------------------------------------------- ----------------- <br /> ----DAFT =J <br /> ADDITIONAL COMMENTS------------------------------------ <br /> ---------------------=------------ ------------------- <br /> �', <br /> ----------- --- -------- - -- --- - ----- --- - ----- ----------- FT--- <br /> Final Inspection by:------------ - ---------CSC/ -- - -----Date. --- X - --- <br /> EH 13 2 Y: `q SAN JOAQUIN LOCAL HEALTH DISTRICT_: Fas 21677 REV. 7/76 3M <br />