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AOR OFFICE USE: FOR OFFICE USE: �. APPLICATION FOR SANITATION PERMIT 7/ f Permit ---- .(Complete in Triplicate) -------- ------- ------- ---- Date Issued=-..5�-__�� 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. 544 and existing Rules and Regulations: �, CENSUS TRACT-- - - + JOB ADDRESS/LOCATION._-_ , I + � �2b�'� - -- --- -------- - - Phone ------ Owner's Name.:----_a. lm-p1-------- ------- :. :_ -- !/ Cit1 Zip----------- Address---- ---------Address.--- ----- G . - Phone h e - Contractor s Name-----.-- I ame__ R � �� Apartment Hous ❑ Commercial.. otel Ot er- -==--"- = ------------------- ---------- ------------- -- railer Court Installation will serve: l ❑ �T Cor i ❑ -- ---- �- t9 r - --- ------- N .� F Number.of living unitsumber.of.bedrooms -='Garbage..Grinder--------.---Lot Size____._-.__.___ r y -_' - -------P to riva EK PP ---_---=-------------I .__Y--:Y--- � Water Supply: System t . Peat ❑ Sand Loam ,Clay Loam ❑ F Character of soil;to a depth d pneet: • ASo'nd ❑ Silt Cla ❑ Y ❑ Y p ❑ dobe Fill Materia!__--:------If Yes, type__._.------<---------- i 1 [Plot plan, showing size of lot, location of system in relation to�wells, buildings,.etc. must be placed on reverse side.] ► ` ; . . NEW INSTALLATION: JNof septic tank -or seepage pit permitted if public sewer is available within 200 feet,] ; PACKAGE TREATMENT [ ] SEPTIC TANK ( ] ' Size. - + : ------ ------- -- Cl Ca acit / yl1`O_ ,T e� c`_ 'c-�- Mater�al:------------------------No. Compartments Y YA: �� e 1 ] f �'T- /Z-7- 0 es_ Foundation-- . ----------- -Prop. Line--- ------------ Distance to nearest: Weis :!s_=..:__•::_ LEACHING LINEA E_] No. of Lines; __, - Length.of each.l'ne th Filter Material Total. Length _. . ,__ - 1 ! 1/ - D' Box. �. ¢ t y rial_f �D P . Type Filter MateTF� +�• - t�, �. e Barest:Wel'I_._ _� Foundation c�� --- Property L'in "Distance to n ----- -- .., C, Q a i Rock Filled #Yes ❑ No SEEPAGE PIT E l P � --- $ umber ---- 1 ..}-_. um Depth Diameter �' ---- . y gftb t Y ------------------- Rock Size D Stan extol nearest: Wel :l = -pth- Foundation - Prop. Line ------------------ { I - -- Date------------`-------------=------ ] REPAIR/ADDITION (Prey.-Sanitation"Per,n'+it�#-_ --__"`'�:--.;-- , ] . ---- -----= --------- --------------------------------- Septic Tank (Spe�ify Requirements)-_=i._= M - --- _ ' ----------------- ------------ --------- Disposal Field (9pecify.Requirementsl��-�----------- ---- - -------- ----- .- 4 -r-------------------- -------------------=--------------------------=--- --- = 4 -------- -- ------ -------- ----------- { w_.` (D�aw ex sting and requiiediaddition on reverse side) i yi I hereby certify that I have prepared this-application-and-that-ttie�work- ill-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: s ) this ermit is'i�ssued, 1 shall not employ any person in such manner as "I certify that m-the performance of`the work for whichp 0 I to become ,subject to or an S. pen�sation caws.of Cal.ifornia.' � Signed ; -------------- - y I : 7 tle----- ------ --- v------ ------- ------ .-- -------- - .;B ------- ----------------------------------- - i i (If-other than .owner} FOkXPARTME13T USE ONLY APPLICATION ACCEPTED; BY':. -. __-DATE DIVISION OF LAND NUMBER . --- ---- --- --- ----DATE----------7-- -- - -�-- - ---------------- ADDITIONAL COMMENTS.__._`.._...------ ------------------ k _ .. !--. i _______________--------------------_----- ----------------------------- - -. - _________________ ______ ___ ___.___�__________.-------------- ------------- - _-.____-_____ ______________ _______________..___.______--__._-__ -------------------- ------------ a .._ '.. _ _ .__.____ ---------- -_ _____ + -_-___.__-________ -� Y ___ ___ __ _ -_ -- __ Final kns action 6 - --------- -- - ------- P y __________��----�-----�-- F&S 21677 REV.7/76 3M EK 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT