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FOR OFFICE USE. FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No.7�.`-�--�.�- <br /> -----------------------------------------.---..-. .-.. <br /> .. � <br /> (Complete in Triplicate) <br /> ----------------- Date Issuedv--:1.3 7-2 <br /> ................................ . <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to-the San Joaquin Local Health District for a permit to construct and install the work herein dscrib <br /> This application is.made in compliance with County Ordinance No. 544 and existing Rules and Regulations: G1 <br /> JOS ADDRESS/LOCATION <br /> --1 SCQIo!�---I, �I�D �------ -------CENSU .�R�T <br /> Owner's Name. �@ A/ Phone. - - <br /> -- -�-r� ------ ,.../.K.i*ZG .Gaf�E�Q. ... .._ j= .. ziad......-. <br /> Address. � .�`` .. � a. .:-. 20. .4. �[�;. City.-.., SCa..a; P Ii <br /> Contractor's Name--- ----------------------------­-- .License # .................... . .Phone... ------- -------- ------• 4 <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ w <br /> Motel ❑ Other. ......... ... <br /> over �a.cre.5. ----- <br /> Number of living units:.....r.....-.._Number of bedrooms...3_.._._Garbage Grinder-...�------Lot Size.................. ......... ....... <br /> ---- --------��-----•--Private �{ <br /> Water Supply: Public System and name---- ------------ ----- " _- - -- - -- - --------- . -- <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt Ej Clay g Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan�< Adobe ❑ Fill Material_. ..- - .:lf yes, type-------------------------- ---- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings,ietc. must be placed on reverse side.] ..� <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] .� <br /> PACKAGE TREATMENT [ ] SEPTIC TANK Si e '...............Ar �... �mN-------"--Liquid Depth.'—----- <br /> L Q,� 1 p -�- q <br /> Matanal_.�.On.Cl]P,�T�•._.-:No. Compartments - <br /> • --------- ---- <br /> y tef. .......Foundation...--- `a !E'...Prop. Line-.-IDA.. <br /> Distance to nearest: Well.-,; /._....�-.- / <br /> Total Length .' ---------------- <br /> LEACHING <br /> o2-a... - <br /> �. __:.Length of each line.- .. -� g i <br /> LEACHING LINE No. of Lines _ .. .. -- � <br /> , s , <br /> D' Box-.f..-.. Type Filter Material_ -Z�.._- Depth Ater Material------- --- ----------- - --- <br /> IV j� L� n Th/ Q--/ ---" Property Line....J� ` No <br /> Distance to nearest: Well--��1�".�------� ---!.Foun ati <br /> / WiUTN f 9 � --------- Rock Filled Yes <br /> SEEPAGEinf [ Depth...�Q.. Dieriafer.--- . Number i <br /> SGt /�'►/?•S Water Table Depth_----_---------- -----`-- ------- - --------------- Size.... -- -- -- <br /> Distance to nearest: Well.- ....-._74 ................Foundation.... -/ ....Prop. Line-------.-- ------ <br /> REPAIR/ADDITION [Prev. Sanitation Permit#.......................... ... Date...-------------------- ---------- -----] <br /> t Septic Tank (Specify Requirementsl...I----------- <br /> � '�------ ----------- - <br /> (z - c- " <br /> Disposal Field (Specify Requirements)......... ..... .....d <br /> -- ---------------------------------- --------------------------- ---------- ....... .......... --------------- ----------------- .. ....... ......... ..... --------4 <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br />' Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents <br /> signature certifies the following: <br /> "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 <br /> to becomes ject to Workman's Compensation�laws of Californi <br /> j <br /> Signed- <br /> By...------ .......... ............. ------------- <br /> ......Title_ ---------------- -----p --- ------- ---------..._... <br /> (if other than owner) <br /> Ir FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY........ .. ------ ---- ---- "------- <br /> �i DATE _1=1-9-77-------- <br /> DIVISIONOF LAND NUMBER_..... --.. -- ------------------- ----------- ----- -------------------------------------- ------- - DATE---- -....----------- -�--..- . --� - - -- --- <br /> ADDITIONAL COMMENTS.- ----------" •------------- <br /> I --- -- ------ ------ ... <br /> -------- ---- --------- --------------i---_------------"- ------•------------ <br /> ........... .............. _ _.__ ..Date.. -- --�_!-0 . <br /> - -------- �- <br /> � Final Ins�ectlon lay:---.- ---- � -"- - - F&S 21877 REV. 7176 3M <br /> EH 13 24 SAN OAQUIN LOCAL HEALTH DISTRICT' <br />