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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----- - -------------------- ----------- -- (Complete in Triplicate) Permit ------- -------�---�------------------ Date _----This Permit Expires 1.Year From-Date Issued Application is hereby made to the San�Jcaquirli Local Heciith District ror a permit to construct and.install the work herein described. This application is made in compliant' with Coupe �.i� s'arid Regulation 1 JOB ADDRESS/LO 10 �--- --I�.QD--- - SUS T ACT_ . ,4 !J r -- --------Phone.4c6��_G'p®E Owner's Name.-..- -- - -- - -- -- - =------- - --- - -- - ---- -------- - --- ------------ -----------cc------ -- ------ ------ L 11 Address.......7 #7 .u1 - - ---------------------- -------------City- .4.,i_-:. -... = Zip p �- �} -t = 44-- --------Phone_�16.=.F- - Contractor's Name-- v__.#3,--- Nr Installation #----�-- . Installation will serve: ' ce-O - Apartment House❑ Commercial ❑' Trailer-Court-C] Motel ❑ Other-----------------------------------------L_ Number of living units----- ----------Number of bedroom Garbage Grinder------------Lot Size___ -5--15' •------------- -- I _ Water Supply. Public System and name--------------- -------------------------------------------------' ------------- -------------------------------Private 4 Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam Hardpan,'�Adobe' J Fill Material-_..........If yes, type______-4------. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLA71ON: {No septic tank or seepage pit permitted public sewer is available within 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK ize-_ '' 1_/----------- -------------Liquid Deptth.- _----___--- QQ ,Lnc No. Com artments h.� -------- Capacity_ .8QQ.----Type. - Materia! p Distance to nearest: Well.-.(cp_-:0-----------------------`---_-__-Foundation-- ---------------Prop. Line---/---.----- --� r a LEACHING LINE No. of Lines__ _____ _ _____________ Lmngth-ztFea41ins.___�d_�_- - --------Total Length.-_j 4-0 1________---------- -__ D' Box �. TYpe Filter,Material- `Depth`Filte Ma aal- {'$- A `C Distance to nearest: Well_: C�:__"'"__.--__._Foundation--- _ _----- Property Line - ,�9---------------- } SEEPAGE PIT [ Depth__.. _. .+__Diameter-� --------Number- ______-----_--_----_--- Rock Filled Yes, No[t ,- Rock -,-,. --------------- -- ,Size Water Table Depth— Distance to nearest: Well:-- ------------ ---------------------Foundation.-_-_-- --- ---------.Prop. bnetj-- _ _-,_;--------- . -Q REPAIR/ADDiT1ON (Prev. Sanitation Permit#------- ----------------,----------------------Dafie-------------------------------------- --- --- 1 i =R`�----------- Septic�Tank (Specify Requirements) = f -------- --- --- Disposal Field {Specify Requirements)----------'----------- -- ----- ------------------------------------------------ Y lei"e ' ----- -- ------------------ -------------------- -------------- ----- r -- f ---------- L --- ---- 4 (Draw existing and requires! addition on reverse side} � 1 hereby certify that I have prepared this application nnd,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: .7. . r , '"I certify that in the performan, of the`work for which this permit is issued, I shall not employ any person in such manner.as , to beco sub'ect orkl s Cam sation laws of.California." r-.- r�IL12 t.�.i •+tion �+ 5i ned_ I p.. g __ • � -- �Owrrea�— BY--------------------------- ----------------------------_Y--------- L! F-__ .-Title 11?� p�------------- ------------------------- (If other than)owne (� . , ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- - ---- ----------- --------------------------------------------------------------------- ------DATE.- �l /------------- DIVISION OF LAND NUMBER... r ' '� ---------------------- -DATE ADDITIONALCOMMENTS------------------- ---------------- - ----------------.-- --------------------- ------------------------------------------- --- ------------------------ - r --------------------------------------------------------------------------------------------------------------------------------------------I- ----------------------------------------------- ------------------- - - Final Inspection by---------- - ---- ---- - -- Date...-_ " �77 -� EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 REV. 7/76 3M