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FOR OFFICE USE. FOR OFFICE USE: APPLIEkffQN-FOR SANITATION PERMIT ------0 [Complete in Triplicate) Permit No.-__ ___- -------------- ----------------- ------------ 3-'2/-77 "" Date .Issued______ ---------------------------------------------_----------- 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:�T - --------------- f/�-__ __ --___ - .____- __ ________ � JJOB ADDRESS/LOCATION_...Owner's Name- ----- - - ---------- --------- Address---- -------- hone -y i Addressl - r License - - + p �'_------ -- = Contractor's Name- - -- /9 ne � f --- Contractor f ho" Installation-will serve: ` Residenc Apartment House.❑ Commercial ❑ Trailer Court❑ tel ❑ Other-,. -:- --=---"-------- -------------- --------- - Garbage Grinder------------Lat Size.___ Number of living units----- ---- ----Number of bedroornsz._ �• ---y l/„ Water Supply: Public System and name.;&,_' = - Private Character of soil to a depth of 3 feet: `: Sdnd'E Silt ,Clay ❑ Peat ❑ Sandy Loam ❑ Gay Loa ' Hardpan Q Adobe�-<ill Material-_,.___-If yes, type-- _-________________.__.-" (Plot pian, showing size of lot, location of system in rel ati n to,well�busldings, etc. must be placed on reverse side.) NEW INSTALLATION:" t(No�septic tank or seepage pit permitted if publ�sewer is available within 200 feet,) PACKAGE TREATMENT I '1" SEPTIC TANK ['] ' Size` :_-:--_'�" "-- ----_--`-----Liquid Depth._;__-------------- Capacity ___-- ��`�TYPe-,, -----=-='=-_Material---- - No. Compartments--------. -------- --------- _. "Distance,to nearest: Well------ -------------Foundation Line---------- f LEACHING LINE [ ] No. of Lines----------- -- Length of each line.___'____ * --Total Length._-_ _ Q____-____,_.__.,_____. 'D' Box------------Type Filter Material--------------------Depth Filter.Material---------------------------------------------------------.-------------- - Distance to nearest: Wel l__------'.------________-----Foundation----------------- Property Line--____!1--0------ 4 T [ ] Depth, � __ ilarr�eter :_ Numkier_._ Rock Filled Yeses] , No # _ Water table Depth--------- ------------ -------- ] --------------- Rock Size---- ~' : -------------------- - j / Foundation__r'^ � -- -- _Pro Line[ t Distance to nearest: Well f -- .""----------- -- P. ---------------------------- REPAIR/ADDITION-(Prev. Sanitation Permit#---------------------=---------------------=_----.Date-------- ------------ ---------------1 Septic Tank (Specify Requirements)-----------------------------------------------------------�f ------------------------------------------------------------ --- ------------------- --------- Disposal Field (Specify Requirements)---------- -------- " -----=-------------------- -------------------------- --------------------------------------- ------------------------------------ ------ . ----- - • - {Draw existing and required addition-on reverse side I ' I hereby certify that'I have,prepared this application -and that the work-will b4 done in-accordance with San Joaquin-County Ordinances,' State Laws, and Rules and Regulations of the Sari Joaquin Local Health District, Home owner or licensed agents signature certifies the following: t "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 of _California.','. -**�4 I Signed.:-- ] _ ----------- ---:Ownri s-BY-------- it , =u an o nert 'FORr DEPARTMENT US ONLY' APPLICATION ACCEPTED-BY=- ' R` = = = = = `.I]ATE. _-. I' 7 . DIVISION OF LAND NUMBER.------------------ ---------------------------------------- ------------------- DATE - / ADDITIONALCOMMENTS--"---------!- ------------------------------------------------------ --------------=------------------------=_.--------------------------------------------------- ----_ - ------------------------------------------------------ s ------------------ - ----------------------------------------------- .. - -- ----- - - ------- ------------------------------- ' = :: = - ; ate_.. -rr- = :-L. _________________ ____________________________________________"_ ___-___ __---------------------------------------------.___-___-_ Final Inspection by:---- -- D EH 0 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fes 21677 REV. ��