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FOR OFFICE USE: FOR OFFICE USE: <br /> PPLICATION FOR SANITATION PERMIT <br /> ............................T ........... (Complete In Tliplicatel Permit No.2. 70.. <br /> ..................... Date Issued../�317729 <br /> .............................._......... This Permit Expires 5 Year From Date Issued <br /> Application is hereby made tq the $an Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in c�ompliance�with County nouun +`Olydinance No. 5:59 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION..!`/ 7 - -AlL ....... i.....Gf r��..�%..CENSUS TRACT................................ <br /> -r.............................. <br /> Phone. <br /> .-.. ...... ... 5 � _ ... ... 9 ... ....Owner's Name. <br /> Address... <br /> t��.1._..... . �... . ,........... ......'.........................:..........City...!/c1 L Zip..��.�3:7�........ <br /> Contractor's Name V. !.f<./ �LO!�/l�/V{5..._. ......!...............--.._..license #.!9T97Z _.Phone.-wQ^-'',g.'�3Q.7......... <br /> Installation will serve: Residence [ Apgrtment House[] Commercial ❑ Trailer Court ❑ <br /> Motel [j Other............:_ - <br /> Number of living units;....P./...Number of bedrooms-.sJ..;_Garbage Grinder.........-Aot Size...1Z <br /> ... ............. ................................ <br /> Water Supply: Public System and name........-........ '. ................ ........... ...... -"....._ "- -------- .......---.... ................ .....Private Z <br /> Character of soil to a depth of 3 feet: Sand E] ` $Ht C] Clay C] Peat p Sandy Loam ❑ Clay Loam E]Hardpan Adobe ❑ Fill Material............If yes,type............................_... Q, <br /> [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) S <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sew is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK ] Size.. iRD-b ...... ..........._....._..-.-------Liquid Depth.........................I� <br /> P ty a .Type......:................Materia---No. Compartments- '�------- ...............Is <br /> Ca aci l�.aid" <br /> p l <br /> Distance to nearest: Well---45d-1.............................Foundation...../.. ....,........Prop. Line---_. S-1............ <br /> q <br /> LEACHING LINE [ J No. of Lines.......... ...:...........Length ofoac,h�a�line..._•...4.0 <br /> ............Total Length ......Al.p...r................ <br /> D' Boz....I......Type Filter Materialjy%.; J..t Depth Filter Material-17..:.................................................... <br /> Distance to nearest: Well..-- .... Foundation.,....3d...............Property Line.-.. .................... <br /> SEEPAGE PIT .[ ] Depth............. <br /> Diameter..- . ..............Number....:............................ Rock Filled Yes ❑ No❑ <br /> WaterTable Depth..........d......"- .................................Rock Size.............................. ................. <br /> Distance to nearest: Well...,.:::..::........1......................Foundation..........................Prop. Line........................... <br /> REPAIR/ADDITION (Prev. SonitationzPermit#................... ..................................Dote.........:,........_--------..-..............) <br /> Septic Tank (Specify Requirements)_%; ................ +-1................... - '---"... . ...... <br /> DisposalField (Specify Requirements),,.....**........ ............... ............... ............ ----­------- ..................................................--"'-'..... <br /> ......................................................................-.....................................,....------...................-................I............... ................................ <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 Regylations 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 becom lac to orkman' Compenfation laws of, C lifornia." <br /> Signed.. .. ..!..... .'.._-/ 1.p/ 'Y� E.!✓ :,.... ..t[?E! ...... <br /> By................ .'•- .................. '...'............... ..................;----------------.... --Title.-----...:-z............................................................. <br /> (If other than owner) <br /> v FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. ..... . . .. .s. .. ............... .... ..DATE .... 1:7 . .....:......... . <br /> DIVISION OF LAND NUMBER............. .• ............... ..... ......... . ."........._..;-------.. DATE................................................ <br /> C •. <br /> ADDITIONAL COMMENTS_,._ :. <br /> .............. ............................................. .. '-'........................................... <br /> ............ . ............... -..._.... ......... ........ ..................................C--------.......-------•------------------------- ........................................................ <br /> .. ......................._ .._................. ....... ... �..`...] <br /> ................ l <br /> FinalInspection by:..........__............. VAI ........---'-........................Date.......- �.. ... .........- ....... <br /> of 13 24 SAQUIN.LOCAL HEALTH DISTRICT Fes 21677 REV. 7ne 3M <br />