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FZR OFFICE USE: ' <br /> �..- ........................ <br /> APPLICATION FOR SANITATION PERMIT <br /> . <br /> (Complete in Triplicate? Permit No. ....­.......I.._... <br /> ......................... .................... <br /> This Permit Expires I Year From Date Issued Date Issued ...7............. <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> Ik <br /> JOB ADDRESS/LOCATION CENSUS TRACT .......................... <br /> Owner's Name- ...A41-e. (C.......Cr. l�3 .!/�Ic'C� �7 <br /> Phone . -- <br /> 8r <br /> ................... <br /> Address ....__. _�J 1 1. /.� .. ........ 0 �T,. <br /> -. City <br /> ._._... <br /> Contractor's Name ---'------------------------------------------------ 1 <br /> ----License # Q]- ± Phone ------..:..................... <br /> Installation will serve: Residence Apartment House 0 Commercial ❑Trciiler Court <br /> Motel ❑Other .............................._............ J/2-A-C_A�� <br /> Number of living units:._...._. Number of bedrooms ---3......Garbage Grinder ............ Lot Size .._­.­1.__.............................. <br /> Water Supply: Public System and name --------------------------------......--------------------------._..._ ...................._......... ......--_Private ❑ _ <br /> Character of soil to a depth of 3 feet: f Sand D Silt❑ Clay ❑� Peat❑ Sandy Loamy Clay Loam <br /> Hardpan ❑ Adobe ❑ Fill Material _..._._.__ If yes,type ____________________________ <br /> (Plot plan, showing size of lot, location ofsystem 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 a ilable within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TAN Slze...._.� � .- ._..__... Liquid Depth .......................... <br /> p y • Type -- Material- .-- -.I No. Compartments ....... <br /> �¢ r--;z....... <br /> 4-s <br /> Distance to nearest: Well ...fr . .....f..........Foundation' ....e.10......... Prop. Line E................. <br /> LEACHING LINENo. of Lines <br /> [y� Length of each _ c./</Total length ._.. 2�.._...._. <br /> 'D' Box .._�.---- Type Filter Materia.- -�---z D pth Filter Ma�rial ...... .. .............7.............. <br /> Distance to nearest:f`W911 r Foundation,......./_ K Property line ... ..:........ <br /> SEEPAGE PIT [ ) Depth 192----. ' Diameter ---------------- Number ............................ Rack Filled Yes ❑ - No Q <br /> c7a?2 5' Water Table Depth -•-•-------------••-•-•-•----......•--••••-----Rock Size --------•--•---------•••. --•-- <br /> Distance to nearest: Well ........................................Foundation - Prop. Line <br /> REPAIR/ADDITION IPrev. Sanitation Permit# -------------------------------------------- Date .................................. <br /> ) <br /> Septic Tank (Specify Requirements) .... .. ..... •--/-..-..---•- --. 1------------------- <br /> --- _.. <br /> Disposal Field (Specify Requirement - -_C1.-�------ -- ------ ------- - <br /> -----•---------------------------------------------------••---•-- .............................................................................._. -------. ---•-- <br /> - -----------------------------------------------------------------------------------------------------------...... -•--•--•-••----•-••- <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 <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. dome owner or licen. <br /> sed agents 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 <br /> as to becom bject o r an's Compensation laws of California." <br /> Signed ._.. �rC _.(��__` s ..... Owner <br /> BY ---------- ----- ............................... ---.............. ........ ........................... Title ................... <br /> (if other than owner) <br /> R DEPARTME�j USE ONLY <br /> APPLICATION ACCEPTED BY _._... --• -•--- ...............I............ -•..............•--........I............. DATE ......7.-.1.Z `7......... <br /> .. . <br /> BUILDING PERMIT ISSUED ..... .................... <br /> ....•---....... . ---•-------- ----...-----------------•--------•.........._DATE _.......• <br /> ADDITIONALCOMMENTS .......................................................... --•-----..........._._..................._._._.._._.._..----.......----:....-.._._.--_............ ' <br /> ..........•. ...................--• -••-••.. -/. _.... :`y '- ---------- ---------------------•- ...............................................___.....-..... <br /> Final Inspection by: ....................................Date ..?.... 11.- .... <br /> SAN JO UIN LOCAL HEALTH DISTRICT <br /> E. H. 13 24 W6$ Rev. 5M 7/7231%1 <br />