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FOR OFFICE USE: FOR OFFICE USE: APPLICATION'FOR SANITATION PERMIT - 6 ` 1 Permit No. -_ _.___-_- ,�� IComple'tewn.Triplicate} r_u ---------------- ------- -------------------------- ---- � ► 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: CENSUS TRA ----------1�.� JOB ADDRESS/LOCATION - ---- -- --�-�- - �� ` Owner's Name 1/L� r - _ Phone Address.-- . O ----=----- Cit, G-- --�C� Z'P IIIIII'},, " ' i�� A 'l'- _ ' -------License .#. ✓------- Phone - -- -- ------ Contractor s Name__._ �_ - Installation will serve: Resident A' artment House. Commercial ❑ :Trailer Court ❑ Motel [71Other t -I i • �f ' �--- -------- - Number of living units:__-__._._------Number of bedrooms_._---------Garbage Grinder..='.---___`_Lot-Size______ ___ ____ Water Supply: Public System and name--------- "-----------.�---------- ------- _ --Pn 't .�- �-. . vats Character of soil to a depth of 3 feet: --Sand ❑Silt❑Clay ❑ Peat ❑ Sand'y';Loam Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material_ - If_ es, Y..,_ [Plot plan, showing size of lot,'location of syster�in relation to wells, buildings,,etc. must be placed'on�reverse side.] 'A-Y. t. >. NEW INSTALLATION: (No septic tank�or seepage pit permitted if public sewer is available within 20d feeJ. 't,] .:., �/ s _ � � - uid Depth_.: - - ------- PACKAGE Y YP Ca acit j-LA�7 T e. - ;./ 7_ ftp PACKAGE TREATMENT { ] SEPTIC TA izei Material__��'-�------No.,.Cbm�partments__..___ ^ -:=`--___-- to nearest: Well_.____ (-� ----------------- 4 - =--- foundation,._ .__.__ — Prop Line._--------------------------- Distance' No. of Lines-----.-_.--N --- --.--.-.Len Length of eachli e' !-� �y , LEACHING LINE [�-]� � ' - , g ---.-- ':---.Total Length.-_..__ - � ---------- / i- -------------------� D' Bo --- e Filter,Material_- __ fJepthtiFilter_Materlal____" ------- -----=- ----- -- -- Distance #o nearest: Well °__. -------- �_�Foundatio'n ___ --------------Property Lin e:. ____.._____------- i. . /5 y - -Number . � '- - Y j R� Filled Ye 's��No❑ .--SPIT E-1 _ Depth-f --- --=---- �'-'-------- r_ I i- Water Table Depth._----- ------ - ---.Rock Size: f = - / S ------------ - Distance'so nearest: 1NelI> ��--------------------- Faundation._._! �_ ---_ ---Prop. L'rne-f/1__ i REPAIR/ADDITION (Prev. Sanitation-Permit#- _: '�- - `----=-==------ -- Date___- __-.------------------ -------------------} F Septic Tank (Specify-Requirements):..__.-:. -..� L� i `>`- --- --=--i-==--- ------------ --- ---=---=------------------------,----------- - -------- ; Disposal Field (Specify Requirements) - - ^=`--'-' -- -------•-- ------------------------------------------------------------------- ------------ ------------ ---------------------- --------- - _ F _________ - ------------------------------ --------- - - ----- - (praw existing and required addition on reverse side) - hereby certify that I have prepared this application-and that the.'work- will be done in accordance with San Joaquin County r Ordinances, State Laws, and Rules:and Regulations of 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, 1 shall not employ any person in such manner jas F to become subject to Workma 's Compensation laws of California." l I � ; ' Signed._ ---:-. `^i ... -- - Y --- - - f _ n er ---------- ------------.-Title- _G_-�----------- - -- FOR DEPART} (If otherthan"owner) MENT USE ONLY -- ' p r. APPLICATION ACCEPTED BY-_:-- -------------------------------- ---- -----DATE- _ _/.��. '' - `- - DIVISION OF LAND NUMBER ------------- :. _ ._ ----------- DATE._ ADDITIONALCOMMENTS- --- ------------------ --------------- -------------------------------------------------- - ----------- ------------- --- -------------------- -------------------- -------------------------------------------------- ----- -------------------------------------------- --- ----------- ---- -------------------- --------------------------- ----- D ------------- - - ---- Final Inspection b EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fos 21677 REV. 7/76 3M