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F mi OFFICE USE: FOR OFFICE USE: <br /> +- APPLICATION FOR SANITATION PERMIT <br /> #..._._......... ....... <br /> (Complete i. Triplicate) Permit No. 7-1 -'.2."f� <br /> . .. .-_- <br /> --------- ------------------ -- -- --- ----- ------- Date Issued..T.7.3/,-7t <br /> s....... ............................................ This Permit Expires 1 Year From Date Issued <br /> D <br /> Application is hereby made to.the Son Joaquin Local Health District for a permit?o�onstructand install the work herein described. <br /> This application7.0 made i�n. compli nSe wit .,,oynty rdi anc��Jj9 and�ex�ting Rules and Regulations: <br /> ,Nam ((�� . . -y(K..'.►............:...... .... -- .............Phone. � L <br /> JOB ADDRESS/ <br /> LOCATION. '.„�!`'�. �. 1'1C.'........ �►2t+ � CENSUS <br /> 1 1 <br /> Address---- ....._._.. 't -2 .. ._..--- ...... . - -- .. .... ...... .. .._ Ci . ..Zi 5SZ4..l!......._ <br /> Gentractor's Name.. _ .-_..License #_��..��..._Phone- Z.E5$-----... <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial)jr Tr iler Court ❑� <br /> Y <br /> Motel ❑ Other.._-___. _ J0V-ropL2 (1\akimu.m <br /> Number of living units:... ------------Number of bedrooms........ Garbage Grinder------_-----Lot Size............... . .. . . ......................... .. <br /> Water Supply: Public System and name.. ._ __...... .............................. ._ ._.._.. ................ .......--- .._......._...._._............ ------.Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam X Cloy 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,) Rq� <br /> PACKAGE TREATMENT [ ] SEPTIC TANK ( ] Size .. ..4 f <`�_Ct t. ---------Liquid Depth..rrepa-a�C <br /> Capacity-..._ ...... ._-- Type...._ ..._..... ......Material__Cd.(1Ar.Q,l,-CNo. Compartments..._. .�.........-.•.Q <br /> Distance to nearest: Well....Z130%.... .._ . ._. .._.....Foundation.....��.�_._..... .. Prop. Line--- ... .............. -------- <br /> 'D' BoxYff -Filter Filter Material.1l _.. Depth Filter Material.. .7�..._..._..... ............. ............. io <br /> Distance to nearest: Well.... Foundation---- - --------------- Property Line..�.0... _ ..__ .... ... <br /> SEEPAGE PIT [ ] Depth.. ...._.. .__Diameter--------------- -----Number................................ Rock Filled Yes ❑ No [ <br /> Water Table Depth... ...................---.. .... - - - .- .....Rock Size.- _......._ ...... .................... <br /> Distance to nearest: Well._..._......._..__......... .........Foundation..._.._._.. . . ...Prop- Line........ <br /> REPAIR/ADDITION (Prev. Sanitation Permit#........................... . .... ...............Date... ... /A <br /> - ] <br /> Septic Tank (Specify Requirements)_.. . .. _--------------------. _.....�i�y- � � -.._..._ ..... .. ` <br /> -- - <br /> Disposal Field (Specify Requirements) ............. ... ... �A� .. .....ppb .----------- -- <br /> ---•-- -. ........._......................... ......... - - <br /> � sem' .......... ..... .�..� ................ <br /> .._..... <br /> ................... ... <br /> (Draw exis ing and required additi -olve si <br /> I hereby certify that I have prepared this applic ioa_ n 'rkVVwwwil �_��/,/,r`�a a 11 accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regul tion e.Son,J ellshlllt <br /> i3tricf, H e owner or licensed agents <br /> signature certifies the following: h ,f'{ ��/�����i <br /> "I certify that in the performance of the work for ch tlw/Qrml issa oy any person in such manner as <br /> to become subject to Workman's Compensation la of California." <br /> 6" \ Ca- <br /> Signed.._ . . f`�`- ...... .._ <br /> By----- .- ..... _ ... ... ... . . -.. Title_ <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY / <br /> APPLICATION ACCEPTED BY............ -- .._.....- DATE ....... ..3.Z. -.7. ... _... ..... .. <br /> DIVISION OF LAND NUMBER............... _.. ...._.........-._.........._.... - - -......DATE..__.---.._.._.. <br /> ADDITIONAL COMMENTS ... -- ......_._... . <br /> -.I'Cv.CAr._.for.-----(-Q.v..aJo_..e.lk. 4.as.i Dt,....Q.r..Pc4,..............................._....... --- - -. .. _ .... <br /> -------------------- ------ --------I--- ---------- - ........ -------------------------------------------------- ------------------ .......... . -- .... -......... ........ ...._... ... .... <br /> --------- ------------ -------------------------------- -- . . ..._..... •----------- ----_...._....-.._..---...-...... - ...... .. - ---...----- .-- -..._. ..... I.. .......... <br /> FinalInspection by:....... ........... _ ... _ _......_...... .- ....._ -........... .- ....... - .....Date..................----- - ---- ----....... ..... <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT YU06IN T(JD F85 21677 REV. 71763M <br /> i <br />