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[ FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT `�S 3 � -------- ------------------------------------------------ (Complete in Triplicate _7 Permit No.. kr_T --------------------------------------------------------- yy o7- �� 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: i , JOB ADDRESS/LOCATION G/$'-----5 . ----- ----- -- ------' --------= .CENSUS TRACT. Owner's Name-..--.... ----- ---- --- -------------------=----- -- ---- ----- ---- ---- --- - ----------------- ----------Phone------------ ' Address-----1.3-4915----------- rJc City ` y ---------- ------ --Zip----- ----- ------------------ Contractor's Name1 /9_C+J. 7' ,�41P�`! I_��.--�'�A,, ` ------ License #--7477.1.2-----Phone 4-1-r---3VI-_ r/1 Installation will,serve: Residence Apartment House.❑ Commercial ❑ ,Trailer Court ❑ Motel ❑ Other------------- ---- ---- - ---_ -- �. .._ . Number of living units:__,_._..�------Number.of.bedrooms _._--Garbage Grinder_.----------.Lot Si1e_27XX_140jf�'L��'_1K Water Supply: Public System and 2name- ------------------' ------ ----------- -- . ` ------- - _ :.-Private Character of soil to a depth of 3 feet: ' Sand ❑ Silt❑ Clay ❑ Peat[] Sandy Loam.❑--'�CClay Loam.0_- Hardpan ❑ Adobe Fill Material-----,------lf yes, type-- ------------------------- (Plot plan, showing size bf lot, location of system in relation to wells, buildings etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank for seepage pit permitted if..public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] a SEPTIC TANK"j�(JSiie'%• __._ �" �'- Depth--- ----------- ._._ i P l ' Capacity__ _ _p� Type_.._„ { :___._Material No. Compa :.� rtments_{ - == Distance;to nearest_,Well--=-_--- =5�9_ ----- ----- a-�• .--.:-<<=.Prop.-Line--_- r I----`-'--- - Foundation.- f._'_ LEACHING LINE No. of_Lines___y' . ---:_.'-_ :. Length of each bine-------?0--------.-`-.----.Total Length.;---1 7.0_--------------------- -- s ;D' Box ---Type Filter Material _--Depth Filter Material- -_�l_=_------____________________i----.--------_+---- „,✓,.Distcince to nedrest: Well-: I..... .__----'_-----Foundation-_'_.L3-------'-------Property Line__:_ --------------- SEEPAGE PIT. [ Depth------ _.--.-_ _Diameter- ------Number-----------------I-_--_-----.--_ Rock Filled Yes'❑ No ❑ r ; Water Table--Depth.'-------"----,-- ------------------------------------ Rock Size:_---- -_- ------------------------------------ Distance to nearest: Well---'----'-------------=-- -----------------Foundation--------------- --__.Prop. Line_------------------------ REPAIR/ADDITION (Prev. Sanitation Permit#___._.___'_________________ _ =' Date :__.. ..� "='= ---1: +, Septic Tank(Specify Requirerrnents[_.._/ 04 ' /9��w.v ? a ' ` ---f- -- ----=--- Disposal Field (Specify Requirements)___________________ _ -, & ` --(Draw existing '66d '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 Ordin6ces, State Laws', and -Ruless ncl_Regulat o s of the Sari Joaquin Local Health District, Home owner or licensed agents signature certifies the following: "1 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 becomesu ct to Workman's xCompensati Ion aws of•California."�., ,. Signed-' .-[/��yr/6S -. _Cwnar k By-' ------------ ----- -------------------------------- --- =-------Title- ----------- ---- ----- --------------------------- (If other than:owner) f f _ -FOR DEP RTMEN USE ONLY' APPLICATION' ACCEPTED'.BY,'&-' 'Esc - -�DATEr -' '�'---r____-------'--__ -- _..: L._ r DIVISION OF LAND NUMBER: --=--- -------------------------------------------------------------- ----DATE . ---- ------------ _ _ ADDITIONALCOMMENTS =--------------------=---------------------------------------------------- - ----- -------- . -------------------------------------- , r _________------------ _------------------ ------ ___-----_---__--..--______-- •e ------------------------------------------ - ---- --------------------------------- - ---------------- ------ ------------- ------ -- -------'-- ---------------------------------- -- - " 1 1 r Final lns ection b "�- � � ---- �' __Date. _. ' . EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV,.7/76.3M _ a ar