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FOR OFFICE USE: FOR (3FFIC:k u5t: APPLICATION FOR SANITATION PERMIT .................------... - ... . . ....-.._..- •.(Complete in Triplicates Permit Nal. "-Y�At --. Date Issuecl_f..= _9.:.�8� -------------------------------------- - --------- --- -- .............. ::_.. . . .. .'. This Permit Expires 1 Year From Date Issued I - 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:. JOB ADDRESS/LOCATION. f..� 5 _. aCa/!' :...--- ..r.. K d ti----------•CENSUS TRACT---------- ------- ------- - Owner's Name_....... ....-----. ..... .....................: ..... . ...Phpne..... 1�7 lF �7 e y G 7Ai6 Address Cc vr-c a e-C. o?�'. ..-.. zip :.. - l ` ----1�.---YJ -. city- ..t� p } Contractor's Name-..... l l ._/do1�¢�. s ..License #----------•,•---.-....._'....Phone - ..:. ❑ P ❑I ial ❑ Trailer Court ❑ Installation will serve: Residence MoteAO Apartment House t CCom erc , . , - Number of living units:----.,=--Number of bedrooms---..._ --Garbage Grinder...... -."Lot Size....- `39cl.�- _-"- .. i --- --Private Water Supply: Public System and name-- ---- -------------------- ---.........................----------------------=-=" -_.".. ------- Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam [ :Clay Lcidm ' Hardpan ❑ Adobe ❑ Fill Material._ .... ....If yes, type....................--.......... . � h (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed-on reverse side.) NEW .INSTALLATION: (No septic tank or seepage pit permitted if public sewer 's available within 200 feet,). r D ' PACKAGE TREATMENT [ j SEPTIC TANK pq Size_...... ��---------------------------LiDepth.-Y-4-------------- 41ti 1 "QC1. 1 quid I Capacity... 4 .."-...TYPe- ?lr--" as1..Material_�Q c.. ........:.._No. Compartments=------- ------� ..------.--- XA (J r Distance to nearest: Well.. -.---..- I Prop, ---.-_- - i'�--lad- - •--- ----- -Foundation--•----. .0.... ./..�.-...... LINE No. of Lines.........._`-....---'..."--.Length of each line.'-.""--.8d -....._. Total Lengthy-; ---- d------------ ----- ------ LEACHING (/,, 'D' Box....../... Type Filter Materialgef, , '-..PAkDepth Filter Material-------------�. ... ...----------------� -- - s Distance to nearest: Well....._. /_40-r---.- Foundation-------- - ---------- ---Property Line-------- ------- - ------- [ I Depth (.....Number. --------1------------- --- -- Rock Filled Yes ElNo [Ia �VYt1� Water Table Depth.-...--------- Q"-- -- - Rock Size.--- .:7.2 a;!-...... -------- --------- Distance to nearest: Well.--------. ------------------Foundation--- ...... Line..A-5...--.--"--"...------ REPAIR/ADDITION (Prev. Sanitation Permit#---"....................: Date...........----------.--_-------------------1 Septic Tank (Specify Requirements)--------- ----- ---_- -• #t ........... --------------- -- - ----------------------- Disposal Field {Specify Requirements)...-- . .:------------ --------•---- "-.....--."" " ... i --------- •------ -------------------•--- •-------- .......... ------------------------- ..... ---....... ------------------------- --....---------------------•-•--------- ......-- - ------..---- ----- {Draw existing and 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 Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents signature certifies the following: i 1 l "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 4 to become ect to Workman's 4, ,9brisation s of California."/�, Signed. -..- }✓"� - Owner hn, BY. ............. ...........Title-- - (If other than owner) F RD ARTMENT USE ONLY APPLICATION ACCEPTED BY----------- --- ...... -------------- ......--DATE..... -- -- 8 -7.7 ........ DIVISION OF LAND NUMBER...... . :...... - :_ .,-rvT .._......DATE. - ---- ---- ADDITIONAL COMMENTS---- ------ - r-' - ,. I 1. Final lnspecfion b .- -----Date ---fU ........... EH 13 24 SAN JOAQUIN LOCAL HEAL IST ICT FSS 21677 REV. 7/76 3M