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FOR OFFICE USE: FOR OFFICE USE: . "APPLICATION FOR SANITATION PERMIT fete`? \ e rm• `- 3 Dat7 7 e= ----------- ---- 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/LO TION. ---JJ��i 0- - = ------------- ------- ---- ----- - .CENS_US TRACT Owner's`- Jame--. - - - --- - ` -- - --- , :------- -------- ------ -------- ---- - -- hone------------------------------------- Address_ .- � : -- ---------- � ---- -- C'ty �� 0 i p ritractor?s Namet =---- --- ------------- ---------------------- License # �1�r3/ Phone__---------- 6 Ins� .�- -- �...,..� .t . . .- -... ., .. . - _ � . _ ..t ....,.. .. .� T . 0 tallatio will serve: Residences Apartment House.❑ Commercial ❑ Trailer Cort, ❑ _ ! . . 4— Motel ❑. Other--- ' --- ---- r Number df living.units: -/_------NAimber-of...bedroomS; ,Garbage Grmdar lot.Sizer ------------- ------- ---- --- Water Supply: Public System and name------------ ----:.- ------------- --------.t - 3 -- . Privatebkhi Character of soil to a depth of 3 feet: ' Sand E] Silt❑ Clay F] —Sandy`toam-❑ 'Clay Loam ❑ Hard ari ❑ - Fill Material------ yes, type___..______----.- p � Adobe ` _r- �� (Plot plans showing size of lot, location of system in relati7r!9,to wells, buildings, etc. must be!placed on reverse"side.) e NEW INSTALLATION: [No.septic tank -o-r seepage pit-permitted if-public sewer is available within 200 fees) I r PACKAGE TREATMENT [ ] SEPTiC—TANK Size ' s -------. ------------Liquid Depth.-_y.--.- +_ j Copacityf�Q�}- � _Typ �Matea•ial_�__� ______Nol Compartments._-____��__________________�` a ' 'Distance.to near-est:Wel.l._ ____ _________----Founder#aon— _�-----_;:..Prop. Line 3 e / , LEACHING LINE No. of Lines-:--- --.-_- . _,Length of each IinE� � y� y4--.Total Len Lines_:___. ._ th ry ` �Distance� nearest:Filter Well_ ��ial--�E----�F�dation Filter Material-- --��---------------------- ----:- ------------ E .. . F 1� .r Property Line SEEPAGE PITS [ Depth...e ----Diameter.__- .�-_......Number---------- ------------------ 7 �� ` Rock Filled Yesyr No 9 Rock Size --� ^ I Water Table Depth --------------- .. . ---Foundation-__ .. Distance,to nearest: Well--,-��-- - ----------------� � �.-----------.Prop. Line-------- -- ----------=--- REPAIR/ADDITION (Prev, Sanitation Permit#----=---- -------------------- ---- Date- --- ---------------I------ -------------------Septic Tank (Specify- Requirements) ----= ------- = - � i Disposal Field (Specify Requirements)-----.- -,_ _ !'_r r _r"'_�-t" ` ^ ------- -- T --------- -, c- r - = { (Draw existing and required addition on reverse side) + I hereby certify that l have prepared this application and that the-work 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 of the work for which this permit is issued, I shall not employ any person in such manner as to beco ject to W man's Acimpensation:laws..of California." a a Signed--- ---- ---- --- --- -------- :Owner i BY - { L Title =------------------------------------ (If other than owner) f 1 FOR DEPARTMENT USE ONLY a APPLICATION ACCEPTED BY:- -------------- ---- ----------------- -------T------------------DATE._!-' _- _q-- - f ------------- DIVISION OF LAND NUMBER; - --- --- ------ ----------------------------------------- ---- DATE --------- --- --- ------------- ----- - ADDITIONAL COMMENTS------------------ -------•------ ----.----- -=-- ------------ --- -------------•-- ----------- ------ -------------------------------- ----- ----------------------•---•------------- ------------------------------------:---- ---- -- = -------------------------------------------------------------------------------= --- ------------ -- ------------- ------ -------- 'Final ins ection by.:-----..-� =-----= ------=---=-----='"-----------' ----- __Date ---3 ----�---------------------------------- EH -'----- :----- ----- i EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV- 7/76 3M t