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............. � . FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT FOR OFFICE USE; ------------ ----- --------- ------- - - - --------------------- ---- --- ---- (Complete iin,Trip)icate) Permit No.7� - -- --- ------------------ a� This Permit Expires 1 Year From Date Issued Date Issued. Ap * s plication is hereby made to the San Joaquin Local Health District for a permit to This application is made in compliance with unty Ordinance No. 549 and existing Rules and Regulations: construct and install the work herein describe. JOB ADDRESS/LIOCA QN _ � A r Owner's Name-.--- ----------------- --- ---- ---------CENSUS TRACT-41 ---- Address--- �. -.._ o } f - City--- Contractor's Name-." � --____-_- --_. _ ---. zip 32c1 �� ttr7c A" Installation willserve: k• License one__ _ --- -, Residence �.. ,. partment House 0 Commercial e .. ., .. Motel Other---,: z ~ Court ❑ �---- -- --� ----------`--- ❑ Oth Trailer C Number of living units:--_--- - l- Number of.bedrooms_ _.--_Garbage Grinder__. ___-.___Lot Size__. -_ ¢ s�- : r Water Supply: Public System and.name________---- _ Character of soil to a depth of 3 feet: Sand ❑ Sift l �. -----------Private.i- * .� �_•0 Cay ❑ Peat ❑ Sandy Loam ❑ Clay Loam�� Hardpan ❑ • Adobe ❑""'Fil!'Ma erial -. -------:If est e l v - t , (Plot plan, showing size of lot, location of system in relation toywells, buildings,etcE_must be pla ed on reverse side. NEW INSTALLATION: ) ' (No septic tank�orseepage' pit permitted if public sewer isdvc�ilable within 200 feet,) a PACKAGE TREATMENT ` '' f 'J SEPTIC TANK"f,'13. 't ' Sr ! j Ca acct �;..... =- Liquid Depth-------- --- _ . I P Y c yT e' - ; z --------------- s 1! YP ---------- ----- ---- aterial------- ---- ---•- ompartments------------------------- i Distance to nearest:.Well.„- -----__-. -------- e ------------------ ------------- -- ----•--=---- Foundation,r°_�.^� ; LEACHING LINE ) 't Prop Line l.1._ . No. 1 f Lines n ------------------ Lengt o .each line._.--------i :'D' Box---- --- TMaterial-'A--, Total Length -------------- ---------- t YPe Filter Material' --_'_-. ''`'.,,Depth Filter Material_-{ - - .. 7 • r r :Distance to nearest: Well.- ,. r. -- � ----!_Fou dation--------- '3 # ---- - Line- SEEPAGE PIT -- ? .... ... t ` � t .. . .,� � Property �. —�� I l Depth - D-iameter-= = t _ Y -Cmber `` = - , J Rock Filled YeWater tRokSize�.. e it -------_D.stne3to neare�s:t;`Well #u 'F ----- ---.Foundation ~ REPAIR/ADDITION (Prev:Sanitation Permit#_ .__-__;__ -.__ .D i Prop, ine______-_--_-___-_____ I . j'tate_ - ----- _ Septic Tank {Specify Requirements)_ 1__ )� I j. - Disf osal Field(Specify Re uirements�._----- ------- -- ;P �-ee �, c�-e�uc L/ !_. ------ -- -------- ---------- -:----- ----------------- - - --------------- 4 --------- .— �. _ ^. 4 l {Draw exrsti,ng and required addition"on reverse side) �' �`''” f hereby certify+that I have prepared •this appkicatibn and that the work will be -done in accordance wan Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health k Joaquin County � signature certifies the following': - h District Home owner or licensed agents "I certify that in 'theme perFormonce of the work for which this permit is issued, I shall not employ any person in such manner has 'o become subject to War s ,Cbmpensation laws....of....Colifornia." ;rgned- - --- 3y Owner p = n / s = Title - - ------"--- {If othler 'than'owrierJ r ,. . FOR DEPARTM NT USE ONLY i 1PPLICATifON ACCEPTED BY_)__ i = -------- -------- -- )1VlSION OF LAND NUMBER. - - ------- - - I- ----- -- --------------------------DATE.'- e ADDITIONAL COMMENTS- --.DATE---- ---------- ------------ : i I - ----------------------------------- ----- -- ---------_ - --- -- - - ----- - - ------- ------ ------------f ... ----------------------------------------------------- -- ------------------- ------ - ---- - ------ - --------- ------------ --- ----- nal Inspection by:.:___ - - --- ----- 6----- ----- SAN Date = i 2a _ . JO QUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7/76 3M