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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------------------------------- (Complete in Triplicate) Permit No._7-9`_—._ . --------------------------------------------------------- Date lssuedl4D731&78' --------------------------------------------------------- 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: JOB ADDRESS/LOCATION - C-------------------------------------------------- ------ ------.CENSUS TRACT----------------- --------------- Owner's Name---------- e v� .._:./7.Ye-7.0Iv_c�i i --------------- ------------ ---Phone- ---- --- Address--------------5-19�-�--------- ------ -- " City 7 G y dip /y y ScN--=------ ------=-------License #_ 6g S 6 Phone--�-------.- Contractor s Name----- _ . _�'_7"/S��'�- ---f---. _ , installation will serve: Residence [ffl Apartment House.❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other----- ---- ---- Number of living units:-------- -------Number.of bedrooms;.._.---Garbage Grindex___ `_.Lot.Size-----------------------------------__ _----------------------- Water _______- .-_.-_:_.Water Supply: Public System and name----------------- -� ray r Private _.:------ - -- --- -- ---- ---- Character of soil to a depth of 3.feet-. Sand ❑ Silt ❑ -Clay ❑ Peat E] Sandy Loam ❑ Clay Loam 'Hardpan f; Adobe Ef 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 seepage .pit permitted if public sewer is available within 200 feet,) a � PACKAGE TREATMENT [ ] 'SEPTIC TANK' [ ] Size_____ ___________-"____._._- -� - - -Liquid Depth-- ----------------------- Ca pa city- ,OU TYPe /we CS�Material `=----No. Compartments— � V� l P, 1 Distance".to-nearest: Well-------------------------------------------Foundation----1-p_--------------Prop, Line---47-.-/---------------- LEACHING LINE: [°] Na..of Ernes-----------------------------Length of each line-- -�- X-.- -`�- -----.Total .Length------------------------------------ - -- F'!L, Te x'Avd 'D' Box--.-1------Type Filter Material.-140:c_/ - -Depth Filter Material___- -------------------------------------- Distance to nearest: Well_=-___ --------------- -----Foundation-----=-- -5------------.Property Line------------------------------- SEEPAGE PIT [ ] Depth----=-----------Diameter--------------------Numijer---'-------------y____-______-- � � ' Rack Filler! Yes ❑ No❑�- Y � - ---7 _-R-oclr Size----------------------------------------------_). . r Water a e eat ___________________ Dis#ante to nearest: WellFoundation - = .Prop. Line--------------------------- ,------- REP '= Date - AIR/ADDITION (Prev.(Prey. Sanitation Permit#- i Septic Tank (Specify Requirements) --------------------------------------------------- ---------------------------------------------- Disposal ------------------------- ------ -- - Disp osal Field (S ecif Requirements). __-- ______ .__ � " ----- --------------------------------I----------------- ---- --- t ----------------------------------------- _ _ -_ ------_ ______.__.______--_______.----------------- ________ _ ___. F � - _ -_ _ _ ------- __..-__________ _________________ __________..-__.___.___.___...-____.____________ : --------- -------------------------------------------------- --------------------- --------------------- --------------------- ------=--- - -------------------------------------------------------------=--- (Draw existing and required addition on reverse side) #. I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County {` Ordinances, State Laws, and R_ules and Regulations of the. Sari Joaquin Local Health District. Home owner or licensed agents signature certifies the following: r "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--------=- - -- -d - -- ---- Owner { y BY--------- ---- - i------°------ ------------------ --Title------------------- t [If of n owner) ' i FOR-DEPARTMEAT USE ONLY APPLICATION ACCEPTED BY.._, _.._.._DATE..- .__._.0—a ` ---------- DIVISION OF LAND NUMBER ______________________ .DATE-------___-------.----.----_:._ -------------- :: ADDITIONALCOMMENTS---------------------------------------------------------- --------------------------- - _ - --------------- --------------------- --------- -----= -------------------------------- -----------:-------- ---- ---- --------------------------------------- --- - - ---------------------------------------------- --------- -- - ----- -------------- -------------------- - -- ---------------------------------------------------------------- ----------- = -------------- Final-Inspection by:-- ------------------ ------------ - - ------"------- ----- Date. ...`. 7-- 1�----- eH 13 24SAN JOAQUIN LOCAL HEALTH DISTRICT Fos 216�� 6 ori a - I