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y FOR OFFICE USE: FOR OFFICE:USE: <br /> APPLICATION FOR SANITATION PERMIT �( 7'_;',Z7 <br /> ---------------------------------------------------._ Permit No.-- - ---- - <br /> IComplete in Triplicate) <br /> ----------------------------- ---------- - �. P7 <br /> Date Issued__________ ---- <br /> ------------------------------ <br /> + <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 /> �S �NIL�N CENSUS TRACT <br /> JOB ADDRESS/LOCATION L�3 --.. - --------- - --------- .1 --f <br /> Owner's Namei 't` "Ck f't1�Nfi S --------------------- e - - <br /> --------------------- ------ - - <br /> !; <br /> - <br /> ' ,3 f - ----------- <br /> Address. '_.. ----------- �' 1-t1.�-_ =_'.Citjr-------------- ----- ZIP ! <br /> Contractor's Name_____T�?'I- i t � r 3 Y " <br /> ._ icertise # Z y -----Phone---� 3- �� _. <br /> ---`-- M <br /> Installation will serve: Residenc-i ,, �A arlmentlAous ' trriercial ❑ ,Trailer Courts❑ <br /> - �C <br /> om <br /> Motel❑ Gtkrer-?` - J I ` <br /> Number of living units: : _____`______Number of bedrooms-__y G4bage'Grindar_--. <br /> Lot Size 300 K. Ze�O _. <br /> Water Supply: Public System and name---- -' � 1 �` -- ---- ------- "----- --- i. - t--private <br /> + f <br /> Character-of-soil-to-a-depth-of-3-fee#= !Sand ['��Silf-{ , Clams' Pat ❑ {Sandy Loam ❑ Clay Loam ❑ , <br /> N5 Hard"pan ❑Adobe ❑ Fill`Materralz. __-f If yes, type______-____- _ f <br /> k (Plot plan, s_howi'rig"size-of'1ot, location of system in relation to wells, buildings,,et'c. must be placed on reverse side.) ��J <br />€ NEWS INSTALLATION:" {No"•septic tank or seepage pit perrnlitt•ed if public sewe `is available within 200 feet, <br /> `-PA KAGE TREATMENT [ ] SEPTIC TANK [ ] -. 6- - 1- ------ Liquid Depth. .......:_ <br /> 1600.,- ec�xST_ -- a 1G0A_ 'Ae& Compartments---------- <br /> capacity `-� <br /> 'Type r"ji__------- - : Mai 4 I' -Foundafion Cj,y € r `S <br /> ,Distance to nearest: Well_.) �.- _i op ine <br /> a ti <br /> LEACHING LINE ['j No. of L'ines.'_:_.,_ -- Lencith of each line.__.__ 0 [�'�_5 o al Length _-_,_�.:2 --- ------ <br /> s -r"t.� f' i 't s 1 , <br /> 'D' Box............Type Filter Material_, -_:.._ , ,De0th�Filter Material______. - _. _ ---,-- <br /> Distance to nearest: Well--------= ----- -- Line -' <br /> l € ,�' T <br /> SEEPAGE PIT [ ] Depth---''------ ----Diameter--------------------Number_t -- _-- - -----_------------ IL , Ronk Filed Ye❑ No❑ <br /> Foundation_4-- ----- \----.Property <br /> Water Table!Depth----- --------------------------------------- ----------Rock:Size-.__.----- --------��=-------------- <br /> Distance <br /> ---- =- - i .� <br /> Distance to nearest: Well---------------- _. =-•----s Foundation------------r----- Prop.. Lino-------- ------------------ <br /> REPAIR/ADDITION (Prev. Sanitation Permit#-------- -------- --------- -""rDate----.: "'" <br /> Septic Tank (Specify.Req uirem ents)- 1---------:----------------------------------------------------- ----------- --------------------- ----- ----- - <br /> j <br /> ►. 3 44o Le c14 Frecres w-T&4 I2x ,0 � ,_ AT::r=.�. . <br /> Dis ci Field (Specify. .____.- ----------------,_ <br /> P �H hi1C"H ---------- <br /> --------- ---------------- <br /> -----------------------------f -------------------------- w { dry <br /> r € - ---- ---- ----------- ------- <br /> ------------------------------- ------- ------------------ - ---- - ------ <br /> (Draw existing and required addition on reverse side) r <br /> 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 Regulations of,the San Joaquin Local Health'District, Home owner or licensed agents <br /> signature certifiesthefollowings ' 3 <br /> "1 certify that in the performance f the work for which this permit is issued, 1 shall not employ any person in such manner as <br /> to becomes to Workman' Compensation laws of California." <br /> gg r <br /> ' --------- <br /> By <br /> i = = ---Owner „ <br /> Signed.- U►'n r <br /> BY--------=--- ------ ___Title------C�►i-141el�•----------------=- --------------- ----- <br /> k------------------------------- - <br /> e <br /> FO DEPARTMENT USE ONLY <br /> APPLICATION ACCE�E�DEB�Y -------- ---- ------------- -- -----------------.------- - <br /> - -- DATE.-_G--5-—t-�J.1------------------- <br /> DIVISION OF LAND NUMBER - .DATE---------------=-----------I----.----- <br /> w._ r <br /> ADDITIONALCOMMENTS-----= ---- -----=------------------------------------------- ----------=------------------------------- _ <br /> ' ------'---`- -:. _ '—-"- -----------------------------------------------------------------------------------------------•-- <br /> - '"° -------- - <br /> is y't,h.LJ a t <br /> ------- --------------=• - ---------- <br /> -- <br /> --- _ <br /> ----=- --------------- ------------- ---- ----------------------------------------- -- - - <br /> Final Inspection by-------- - -------- --------------------------------------------------------- --Date---------- --------- 2-6n REv.---------- f <br /> EH 13 24 SAN JOAQUIN'LOCAL HEALTH DISTRICT 76 3 <br />