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FOR OFFICE USE: I . ----------------- APPLICATION FOR SANITATION PERMIT LDate OFFICE USE: ' {Complete in Triplicate) o?.._�-.J� __" ------------- -------------..._....... ------------------I This Permit Expires 1 Year From Date Issued Is 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/LOCA TION....A' c ll .� /�@ �, CENSUS TRACT.."-_.. �._.- E Owner's Name.-._._ AL �. , ....TC' .. f a Ah -----------------Phone------- ----- ... Lei-.. ... City.-.- _ . ...... Contractor's Name ..--- .... P ..- Installation will serve; I I .... ......... .._ ... -- .._...License # Phone- Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other..... _ -- ----- --- -- ---- Number of living units:-......_-_.� Number of bedrooms._ C,,,,.. c. `Garbage GrinderlFSS_Lot Size-__""_ Water Supply: Public System alr�d name.. ...................... . .. Private)K P Character of soil to a depth of 3 feet: Sand ❑ Silt[] Clay ❑ Peat ❑ Sandy Loam Clay Loam ❑ , Hard :'p n ❑ Adobe ❑ Fill Material . .... _.If yes, type..................... i (Plot plan, showing size of lot,'Iocation of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: P (No septic tank or seepage pit permitted if public sewer is available within 200 feet,! PACKAGE TREATMENT [ ] SEPTIC TANK 5 ' Size... ....-- �- � S..--- .- -- .Liquid Depth.--------- --- Capacity -------TYPIL' � ----------------Material---------...--------------No. Com artments---. P :.V t l fD7..." . _. I Foundation.."._....`. '..Prop. Lie ....... LEACHING LINE Distance to nearesr ..� ["] Noof ll-ines I` ------Length of each line ____. I Total Length _..�- I ► D' Bo XN-/Type Filter Material................_..Depth Filter Materia!_........_.._.____. - �, �r ----------....... ----- - Distanee to nearest. Well... IDQ._.! . Foundation-: / - -----------Property Line..::_-5L ..---- - .. SEEPAGE PIT P jj3 r De th_.:��-. Diameter... l� ' -- P Number -- ------------- r i Rock Filled YesNo [j { it ..... Water I�able Depth. -----•.... ..... ........... Rock Size-- ---... Distance to nearest: Well.....- f�.O_.-- -----------Foundation...... . / . _.__Prop. Line-- REPAIR/ADDITION ]Prev. Sanitation Permit#--------------- ------ �- ��------..Date----- -- .. Septic Tank (Specify Requirements). i----..... Disposal Field (Specify Requireslents).. - r .............. JDraw existing and required addition on reverse side) I hereby certify that I 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. Nome owner or licensed agen#s signature certifies the following::11. "I certify that in the e of the work for which this permit is issued, 1 shall not employ any person in such manner as performany s Com a sat' laws of California." og eco b'"ct#to Wo a .. . .-- Signed .. ---- ---OwnEsr BY ----- * �a . -- •------ .. ---. - - -------- Title.-- ..... other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED'BY'-=`'.1. ._ .. ... DATE DIVISION OF LAND NUMBER.-.1._�......... .............. ------------- ----------- .......... .- DATE.------------- M. ... ...... -------------------------------- ------ -- ..... .. ... NAL COMMENTS- ----�j~.�. � .��----�-- -..�.. � F � .. ---•------------- - ----•------------------ ---- --- w -- ----------- __ Final Inspection bY�... ..........�.. �= � - -.. ....--- -- --- - - - --Date ...-l/ / - EH 13 24 -' --- � "-- SAN JOAQUIN LOCA HEALTH DISTRICT! F65 21677 REV. 7/76 3M