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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT —1-7- ..2.C�I --------------------------------- -- Permit No......-- -- ---•-- .--- (Complete in Triplicate) - -------------- ----- Date Issue ---_--------- 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. with County Ordinance No. 549 and existing Rules and Regulations: This application is made in compliance �J CENSUS TRACT. JOB ADDRESS/LOCATION------ � �� -- ------ -- -'�.3/'Z Phone.77 0... - ------ -. Owner's Name. ------------ ['� ---city pp zips Address------ ------- �.+ .� y�, .. . - .......License #..3r-z�9_ --- .Phone -- --- -- - - -- - ....... - ContractoPs Name-- .. 8' .... P Trailer Court i Installation will serve: Residence Apartment Haase ❑ Commercial ❑ ❑ ,l Motel ❑ Other-__ .. ------ -------------------- /1 ---------- ------ /1 $- !ll/8 . Number of living units------- ------Number of bedrooms.0_.Garbage Grinder------- ----Lot Size-.---.-...--... . -- Private ❑ Water Supply: Public System and name.- .. .- F Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ „ . 1 Hardpan ❑ Adobe Fill Maieriai , .... ..- If yes, type-•------------- ---- _ C r (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.) vi NEW INSTALLATION-. (No septic tank or seepage .pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] : ,.SEPTIC TANK, [ ] Size. ------------- _:_Liquid Depth---------------- ------- Capacity TYPe------------- - ----- Mate-rial....................... ..No. Compartments..- _..------------ ...... - Distance to nearest: Well_: ---:_•---------- ....... .......- ..._Foundation.......... .. ......Prop. Line ------ ......... .. ....... - ------- LEACHING LINE [ ] No. of Lines -._....-.-.-- .Length of each lino------- -------I---------------Total Length 'D' Box..-- -. ..Type Filter Material....................Depth Filter Material.-._-.- 1 Distance to nearest: 1Nell------------------- ........ Foundation----------------•------- ..Property Line----- ------ -------------------- Rock Filled Yes E] No SEEPAGE PIT [ ) Depth-- ..........Diameter------------ ------Number----------- ------------------ ❑ Water Table,Depth.----•-------- --- ------ --- --- ---------------------Rock Size.-........ ...... ........---------- Distance to nearest: Well---------------- ------- Foundation- Prop. Line-----! ---...Date----------- ------- --- ---- --�---...------- 1 REPAIR/ADDITION (Prev. Sanitation Permit ..-.....--.._....- .- -- ....._ .. 1 Septic Tank (Specify Requirements). _. , ----- , f�._... ... --- - Disposal Field (Specify Requirements .------ ---------------- - -------- -------------- - --- 3 3 �� -- - -. --- --- -.. -- ------- ------ ------ r (Draw existing and re aired addition on reverse s� a I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ! Ordinances, State Laws, and Rules and Regulations of the San Joaquin lova! Health District, Home owner or licensed agents signature certifies the following: f - " I shall not employ any person in such manner as "I certify that in the performance of the work for which this permit is issued, aws -of California." -- - p --Owner i to become subje�t� W rkma Co ensation s Signed... 74--.9 , Title... .._ d (If other than owner) FORD ARTMENT USE ONLY 2 I DACE ,�/ - a� APPLICATION ACCEPTED BY .. ---------------- - DIVISION OF LAND NUMBS --- -- -.-DATE. ---- --- ADDITIONAL COMMENTS_------ --------� -------- ------- ............ ----- -- --- ----- -- --------- ------------- --------------- L. ......... . _. --------------------- ------ -- ...... ---- ------ ------- . r jf -- ---- ----- -- ------ Date . x1 I Final lnspecfion b - ------- ---- Y: ---�-- - - - F&S 21677 REV. 7/76 3M EH 13 24 - SAN JOAQUIN LOCAL HEALTH DISTRICT