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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .................................. ................ P Triplicate) / o (Complete in Tri licate) Permit No..�..... -------------- - _.. Date lssued_!6_. �...7� ............................. --.. ----------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made.in compliance with County Ordinance No. 549 and existing Rules and Regulations: r � J . fr4CENSUS TRACT ..L--....f.o..,'S•--�- �• S.-.-.2 JOB ADDRESS/LOCATION......... SU ------- : ------0, 22Owner's Name...... ..-- �---- --------------------•------------ -�--=•-- --Phone. Address------ 5 -- ..... City------- .......Zip . r5" ... +, 7.- y� Contractor's Name......f!�� - v--: .1`. ..:. 1 V`-!�!1 License # Z ..Phone---��?.z.... _ Installation will serve: Residence 2�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other-_------------------------------------------- Number -------------- ---------------------- Number of living units:---_----....-_Number of bedrooms..---3..Garbage Grindw----YeSLot Size-......c Water Supply: Public System and name --- -- --- ----- ------ -•--------------------------------- --------------_:-------Private Character of soil to a depth of 3 feet: Sand; :] , Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material-...... -_If yes, type........................ ....... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.[ NEW .INSTALLATION: (No septic tank or gseepage pit permitted i�.publJ5 sewer is available within 200 feet) ,J f PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size...... _ _.�� -- --------------------- -- ----Liquid Depth..=:: .�__- ......- ' Capacity-. - Type....VVP�....... erial..-. C t? erf�o. Compartments------: ..---�.-....------ !! !� i Com; Distance to nearest:,Well-----------1.5.0......................Foundation------ --�3--.-...-- .._Prop. Line....c3.-G..-------.._--� 1 LEACHING LINE [ ] No. of Lines ..��....... ..........Length of each liria......�7_s]---.---------__Total Length -. ....--L.7D_ .. CA. �j 'D' Box__.........-Type Filter Material-----eDc.k.-...Depth Filter Material.........1.9............................. ... .... Distance,to nrarest: Weli.._.--/(1 q.,..-..-.__ Foundation..-....•30 ........Property Line_..-.- -5-`-- - d4 SEEPAGE PIT [ ] Depth..p/1.6. .....Diameter-. .33--_-.__Number__'Z------------------------ Rock Filled Yes ❑ No❑ Water Table Depth----n.) ...... ---------- Rock Size.- --------------------- . Distance to nearest.-Well.-J-.- o_f....... Faundation.....1d-0.........Prop. Line...P 5............... Ab REPAIR/ADDITION (Prev. Sanitation Permit.#.- ...-.- : ...... r -- Date.. Septic Tank (Specify Requirements)............................ .. --- ------- ...--------------------......-------- i Disposal Field (Specify Requirements)-- : :. . --- ------ __ r ................................................... .....___"-.... ................ _ :............_........-----------------------------.__......... .-._...................... ...........................................................................................................................................<.-- --- .._...---- -'__--......._._.-...-._-_.-....._.---.-. (Draw existing,and:required addition on reverseiside) F I hereby certify that I have prepared this applicationiand,that the,.w`orlC-Wili"_b4k -done-in accordance with San Joaquin County Ordinances, State Laws,-and Rules-and Regulations of the San Joaquin Local Health District, Home owner or licensed agents I signature certifies the following:- "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 to become subject to Workman's .Compensation laws of California." Signed .. :.---- - Owner --- --- --``.i y-...-...-----.._. . By--------•- L- of-- -- ~-------------------- ---- --Title.----------- --------------------------------------------------- (if -•---------..------------------ ------(If other than owner) s E ! FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY....... .. ... ..:.......:. .--•----...-------------•...-------.._.-...----- --------------.-...DATE _79.... ---...------ DIVISION OF LAND NUMBER.'..................... t, F DATE.---.............._ - ---- ------------- ADDITIONALCOMMENTS--------------------- --------\V.--.....•------------- -------------------------------------- ..-......-------•---- • --...-----.......... .......... - � ;> - -------------------•- •- ---- - --•- -•-----rr ------c�--- --------- ------- -- Final Inspecilon by:-.. c , r �_. --:..Date..._-.b.~��'-Z. 1 --- ------ ---- - -- - EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT i F65 21677�EV..7/.76 3M