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` FOR OFFICE USE: ' FOR OFFICE USE: -------------------------------- -------- --- -- APPLICATION FOR SANITATION PERMITPermit No.79144Fry (Complete in Triplicate) ' --------------------------------------------------------- Date Issued/,?___//_ "-----------------------------_____ _________________ This Permit Expires.l Year1Frorn 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: '_B ADDRE .. _._ �.�,,.�.:.�, r" - - - � - � � -- -� ,�� -, -- � ." CENSUS TRACT_ -_�. _ — JO SS/LOCATI X�� d------- --------.---- i ` �1 _ ...-. --------- ----------------------------------- ---------Phone------ Owner's Name- --- - ---�-�� ---- ---- t s - --- ---- ------------ -------------------------- ---- -- -- f - �L�4` 1`` -a_04'!------Cit " ZAP ,' Address -- ---- -- = .. .,. .. - Contractor's Name----'- � :- _` ------__--'-License --Phone._ --------- .- - � s Installation will:serve: Residence ❑` Apartment House.❑ .Commercial ❑ Trailer Court ❑ s ., } Motel ❑ - Other -------------------------- Number . _..._ r, Number of living units:-_ ._.__._-"_ _Number of bedrooms--------_----Garbage Grinder --.-.-.-Lot Size. _ --_ --------------------- Water .._._ -_ --. - r ' ` Private'❑ la y � .Sift ,Cla - _------------------- ----------::- -"---- Water Supply: Public System and name_._______ .- -_-�------------------------------------------------------------ - Character of soil to a de th odf Qfeet: Ad be. Y ❑ pea Y❑ _ .. andy Loam ❑ _Clay Loam..❑ p ❑ ` ❑ Fill Material .-_- . __ If es, type_._:__ --------------------- },(Plot . ___ ---__._},(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,) p Is 'r PACKAGE TREATMENT (' ) 'SEPTIC TANK [ Sizef --/� _Liquid z_ -- Capacity_ -:--TYP?---f�-AZ all— --- No. Compartments-------- ---- ------------------- .:Distance to nearest: We]I--._"."___-S----- .____ """-._.---:---Foundation_-" ---------------Prop, Line-'_- ............... . ' � Len th f each ling U 4�4- `!'''•Total Len th _ --- ---�-------------- Y LEA NG LINE [[,} No. of Lines--.----- g }:- ' Filter MaterialT "----"Depth Filter Material__'___:,7t " -- ------------------------------------------------ .0.--Type -{. A Distah to nearest: Well-------- ____'Found'anon_-___ ---------------Property Line---------. f -, - ------ l Rock Filled Yes o•❑SEEPAGE PIT Dpth _-_____Diameter .. _ Water Table Depth. ` = ------------- .Rock Size. G ------------- i� : 4, Distance to.'nearest: Well------ = -"-- �--------- = Prop. Line----�/------ ," Uv � Foundation---__-- � � - ' REPAIR/ADDITION (Prev: Sanitation`-Permit#-t'_-----------'------------•----=-- ------Doter--------------------------=-------------------) , Septic Tank (Specify Requirements)-- = -- -:-- = --=---'---- -=-- ------- --=---------:---------...----------------------------- /j ' - _ _.`-"-------------------------------'----------_-_I---------------------------- ,-------_____-------------._--" k i Disposal Field (Specify Requirements)______________' # k ---- - ------ `-------------------- --------------------------------------- -------------------------------------------- ------------ ------*-___-------_ ------------------------------ ---------------------------- - ------- -- -------------- -- = = - -- --- ----------------- ---------------- - ------ -- -- - - {D'raw 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 16gula'tionsi oof t 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 become subject to Workman's' Compensation laws of-Colifornid:". Signed - ------- ---Owner � Title: (If r1 other than owner) r ` FOR DEPARTMENT USE ONLY;--- - } ` APPLICATION ACCEPTED'BY--- ._" '-------------------------=-----------------------DATE. - DIVISIONOF LAND NUMBER --------------------------------- ----------- ------- ------------------------------------------ ------DATE------------------- -------------- ------ ADDITIONAL COMMENTS------------------------------------ ' ' F ------------------------------------------ -------------------- ".. . -------- - ------ --------------- _--- - ---------•------------------------ --- - _ / - -- - - ---------- -------------------- ----- ----------------- ------ ------------------------------ - ' I ---------------------- --------------------- -- --- = Final.,.lns-Inspection by.- - _ �.'-----_------------------- Date = � .. - --. - EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV.�7(76 3h, .