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'FOR OFFICE USE: FOR OFFICE USE: 1 _ APPLICATION FOR SANITATION PERMIT Per No._.t;...-r-^��y� l 7 d -- -------- � (Complete in Triplicate) - Date Issued__..-"z:_- -- 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: n ; f /.5 9� % Sc�. r JOB ADDRESS_/LOCATION._-.,_..,: - 3-- CENSUS TRACTT_/ _ Lf�W - u Phone-- - - - Owners Name ic- ___ :_.._GpN ..-----:-------------- ::-----------::--------- --------.---- -- -- ------ Cit �,�-T Zip Address 1s9�/ c?�-----�--':------N"' y:-: ---------... Contractor's Name__:_ _ _.` -----License # -- Phone' = 4 Installation will serve: 'i Residence P Apartment House ❑ Commercial ❑ Trailer Court ❑ Y, units it _ _y `Number.of.bedrooms-____.Garbage Grinder.._j------ X M1� ' —Motel - .. _ Number of,living Q `^`� �! --�`' ------ "`=-- ---±-x------- Private Water Supply. Public System and name- ----- ,.C-=---...__:r,�--"------------ ------------------��.:��----- ��-� Character of soil to a depth of 3 feif.A Sand ,;Silt'❑ Clay E:1 ' Peat Sandy Loam ❑ Clay Loam 9 r Hardan Adobe ❑�: Fill Material - ---------If yes, type--------------------------- ---- p ❑x (Plot plan, showing size of lot, location of system in-relation to wells, buildings, etc. muss be placed on reverse side.I tan+ if public sewer is available within 200 feet,) J r ._ / PACKAGE T1REA7M NT '[ONi ( ]o,SEPtTIC TANK [+�page..pit P S netted_X ,'-- _�--- --------------Liquid Depth �- ------------ PACKAGE - ----.---:---- f f - , Capacity' = _� - ., -Type-.--- = -- Mater' I r NC &T o. Compartments_ .� - y. . Distance near : Well--------Len 'th of each linea 1�'1 `�- Prop. Line------- -------------- -- -- C 1 - I LEACHING LINE [► - . g ------------------ C 0. _ u g r Total Length D Box--- -----T No. of Lines._______ F�77 [ ype Filter Material_,l`�_<? _---Depth Filter Material ------ _.__-__. -___ =--- :. _ 7 5,_ _=Property Li ne--.-.- ----------------------------- 'Distance e to nearest: Well : __._ _ __.- ______Foundation f Diameter _------------------Number_ ___.- -_ --- w. • SEEPAGE PIT Depth.------ ---- Rock Filled Yes ❑ o [� Water Table Depth =--------------------------------------- ROC Size. x Distance to nearest: Well.`:_---- - -. Foundation-------- --------------- Prop. Line_-------------------- - -- REPAIR/ADDITION [Preva Sanitation Permit#------ .�?5 5 ------------------------Date--- ---------- ---------1 I Septic Tank (Specify Requirements)-__._ T --------------- Disposal Fieldi(Specify Requirements):..__ -.-_Q_)/ - .__.____�_�a_7.- --------1.- _e- -- fe i. M __ --------------- ---.-- ,---- ---------- - T �- -------------------------------------------- ------------ --- ------------------'---'-' _ `:'� "`"` (Draw existing and required addition on reverse side) 1-U. " _ �, ' 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 Ordinances, a , {. y signature certifies the following: "I certify that in the-performance of theworkfor which this permit+is issued,.1 shall"not erriploy any person in such rnanrier as to become ubAlec- By- o rk n's Compensation laws of California.'.' - Sig wned_{ ---- == Owner ___________________________ Title - ---'--`- -- .___.__--.__.___ __ _ (If'other than .ow6er) m + . . FORDEPARTMENT USE ONLY' - E APPLICATION ACCEPTED-BY__ ---- - - - - - DIVISION OF LAND NUMBER' -- _-,----=- ---- - -`---- ------ = DATE ADDITIONAL COMMENTS------ ------------------------------------ ----- -,----------------- - ---------- -------- ___ . . ___---------_---------------------------- _ __________________________________ -----------------------------_---------_______-------____-----------------------_____________ ' __________ __________________________________________________________________________________---------- ------------------------------- _________V l=ines ------------- -- ------------------- pate - --- -- .---- -- - --- -inspection b -- -- p Y - - - ---- ----------------------------------------------------------- EH 13 24 SAN JOAQUIN LOCAL HEALT•H.DISTRICT F8S 2i 677 REV. /75 3M