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FOR'OFFICE USE: W "_ APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: --------------------- (Complete in Triplicate) Permit'No... .�_� > ------------------ ----- This Permit Expires 1 Year Front Date Issued -3 ---- �-- --_.- Date Issued----___-_____ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ,the work herein described. JOB ADDRESS/LOCATION.__';'Gi ` 7-7-1 Owner's Name-.-- CENSUS..TRACT.-- - Address oZp �n ------ ----- -- -- Phon _.._ t- - e - - ... .--- Cit R. ---------------------- Name--: =- - -4- Contractor's Name-- f Y -- ' 6 �L- .. Y z - ---- t� Installation will serve: = ----_License #..✓ T ,Z� one Residence A r, �� --- f artme �i� i �; P nt H,ouse � Ph -- - ❑n Commercial ❑ r r Court ❑ ` Motel. ��OtFier _ - T aile Number of livingunits:_._ r - Number of.,bedrooms:- --__Garbage.Grinder. t'-Size' Water Supply: Public System and name---- :;-- }----_ Lo . ---- fi _ CC-E�. ., ___________ ___ _ ____ _ _ e Character of soil. to a depth of 3 feet: Sand f P t ------- ---- ----- ----_---- __ i . - ❑ 'Silt❑ Clay ;, - -- rive e Hard an _ Y ❑ Peat 0 Sandy Loam [ Clay Loam ❑ 1 Adobe Fill Material...- ------If es, type YPe--------------- - P ❑ Ado (Plot plan, showing � G size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW"INSTALLATION: i - (No"septic' tank'or seepaget s . permified if public sewer is available within 200 feet,) ---------------- PACKAGE TREATMENT:- [.] SEPTIC TANK W[1'J a J�if� I r �. $� Sized =X = X- f 'h Material .- s- Liquid Depth--4------------------ Cap acit ldo— ?---- 'aTYpe_- 'r yt-$ �- .No. Distance to nearest: Via - -=- Compartments-----` LEACHING LINE = Foundation- -_1_p- --,..--,��M.....,,. Prop LFne _. ---------------------- ---- . j No. of Lines._.__- � _ ) � ------Length of each-line. --_,�f► D' Box._ -----Total Length. ) 410 TYAe Filter Material- = _9- �- P ! t y. -De th Filter Material------------(- - - Distance to nearest: Well------- {2�3_�;; -_Foundation._-.._._�.t2- SEEPAGE PIT -1'--- -- Property Line- S-� - I ) Depth._---¢ --- : _ Diameter ------------- ---------- t - Number - Water Table Depth------_----- Rock FilfY e Yes ❑ +� r ) ----.--- Rock Size-- --- �a - Distance to nearest: Well..-_.. _' --- 0 Foun REPAIR/ADDITION (Prev. Sanitation Perm t#.._..- , - Prop, Line_'_________________ ----y ----- Septic Tank (Specify Requirements).---------.I--- . . Date- --------- ----- 1 d ; :------- Disposal Field (Specify Requirements):_-_--_ _ y i -- - ---�---- ' r - � �i r .. --------- ------------------- -1 ----------------------- --------------------- .. ... ._.. __.k«---J--F--R -. _ --------------- ' ' SI ,(W .. -_:._..___.._.__.._..---._- _..._.-_.. ................r_._.__. -- - { - -. .-_.._.._-._----------- -------------------- .............................................� __.- --- _-..-_..__ ------.-------_----------------_-----------------_.__..-__.-___.__ (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the 'wo�k will be 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 signature certifies the following: - ' "I certify that in the performance-of4the;work far which this permit is' issued, 1 shall not employ any person in su to become subject to Workman's. Compensation laws of .Cpliforma.',' P ch 'mannertas t Signed '------------------ ----- I _ BY - ------- ` - - ---Owner Q+/J//f --- ?�2 i 1 ,.. Title LSC j (lf'othei than owner it FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDrBY Dl VISION OF LAND NUMBr R.- N k 5 _DATE_- - . 3 .. -71 � ---- ADDITIONAL COMMENTS- ' DATE. - - ---------- ------- '-, � 5 ------ ------ -------- ------- ---- ------------------- --------- ------------------ -------------------------------- =inal-Ins ection b -----" ------ ------------------------ ------------------------------- ------------- -` --------.---Date------ - - - -- -- -- - ------------ -- ---- - - iH 13 24 - - - ---- - �--�--•-Z- SAN J AQUIN LOCAL HEALTH DISTRICT Fes I? a--UV. 7/76 3- �.