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FOR OFFICE USE: I FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT IM ------------- ------------------------------------- Permit No,-7,.:A2 155'9 (Complete in Triplicate) I �� t�l5s�ed_l :11:7 ........................................._._.__.,, ._.__ This Permit°Expiresrl'Year From Date= Issued r 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: I JOB ADDRESS/LOCATION.._ -- ' ---'-- --.-.-..CENSUS TRACT.__---'-------------------V- 4 - II e 1 s e II , Owner'shame_------ � - �IL- �7--------- - Phone =1 Address '3W [. � - ---City.._- -------------------------ZiAContractor's No, � -- - --_--.---_------ _ .. icense #J- 3 c - Phone-. L 4 e' . Installation swell sea've: z Residence E. -Other---. House. ; Cd'mmercia��_•Trailer Court ❑ Motel Other-------. - g sNuber of livin units:-__. of.bedroom ---�_Garba a Gnndar_' Vd--Lot_Size �O V � l ' Water Supply: Public System and name--- Preva te Character of soil to a depth of 13 feet, Sand ❑ -Silt-F] Clay []Peat❑ Sandy_Loom ❑_-4Clay Loam ❑ Harder n ❑ Adobe Fill Materiakt._�_.-----If yes,type------------------------ ----- r (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be pla!d on reverse 5Jde.) lilt NEW INSTALLATION: (No,s. ptic tank or seepage pit permitted if public sewer is available within 200 feet,] Y PACKAGE TREATMENT'[ ] EPTIC TANK '[j] r rr� ize- ( -------------------------------------- - Liquid Depth.------------------------ e - , CapacitYTYPe =` Material - ._No. Compartments : �I�' =---------------------------- -------- 1 Distance to nearest: Well-------------_-.--- _______ ______Foundation.-------'------ ---------.Prop. Line-s--- LEACHING LINE No. of Lines-_- :. .Length of each line.------....:. ....._. Total Length ---------�� i - 'D' Bok Type Filter Material_ ._'-.--I_,____.Depth Filter Material ! ___ ___________________ _ __ * -_ ------- , 4 Distance to nearest: -- ------.';Foundation _. _.t:_,. ... . ---------- - -- •.----------- ---- Property Line---------------- SEEPAGE PIT [ ] Depth--i__._____- is a elr---------------r_ ---Number_--dation------------------ Rack Fillies Yes ❑ No E] 4 •'# Water;:Table•.Depth------------� ---- -----Rock °Size,,-- ------------------------ _ Distance to nearest: Well _ __--------;Foundation _ . -Prop. Line---- _.__ __ l . 0. _ __ ___._:_ ._ ,t_` - Date � -_-_- ._REPAIR/ADDITION (Prev: Sanitation Permit# = ----------- Septic Tank (Specify.Re uirements1_ Q----- _ ------------------ ilk „ r`. Disposal /Field (Specify Requi�ekm`encs}' � �--`•�= -----_ - -- - �-------------- - -- -------------------------------=---- � -- �ti> - --- ---- ----------------- ---------------------------- --------------------------- ------------------------ -------------------------------------------- --- --- , ----- ----- �i (Draw existing and recluired addi ion on reverse side) ; herebycern that'll have prepared this application and that.the work"'vill be done Yin accordance,with San Joaquin-County certify Pip pp s ., �. , Ordinances, State Laws, a4 Rules and Regulations of the San Joaquin Local Health�District. Home owner or licensed:agents signature certifies the following: rd i "I certify that in the performance of the work for whichethis permit is issued, I shall no employ any person in such manneras to become subject Work s Compe ation laws,of California." I Signed - - - - --�.�---- -• ---�--- --- ------ - . ��-�'=-- Own _ /JA m er f Y t ` . . Title.__ . (If oth4epr"'than ovwner).. . Sti" FOR'DEPARTMENT USE ONLY'"' APPLICATION ACCEPTED. BY: ` - - - -----• ------------- ---- DATE ' xI 7: - DIVISION OF LAND NUMBER:: ----- /� : `""_ - DATE._.. IM. t ; - ADDITIONAL COMMENTS_ ��r ` `tet- ----------------------------------- ------------------ ----------------------- --- � r] A, I R' - G - '----------------------------------------------------------------------- -----_---_-------------_ --------------_------ ___ ,—CC �L ------------------------------------------------------------ i lid �--- ------ ----------------- ------------- ----- -------------- --''� -------- -------- --I er. Fina-fnspecfiion by:__ _ {1�t -_.: " - Date - Y�_: EH 13 24II SAN JOAQUIN LOCAL HEALTH DISTRICT F s 21677 REV. 7/76 3M ` ern. _� _