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' f f F FOR OFFICE USE: OR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7f--/� ----- --------------- -------------------- ------------ Permit No------- {Complete in Triplicate} -- ------ ----------------- ----------------------------------- D to Issug 6-s-7� ..... ------_-----_-----------------------Z---------- __ This Permit Expires 1 Year From Date Issued 1 Application is hereby made to the.San Joaquin Local:Health District for permit to construct and install the work here'�" '®`- gi described: This application-is made in-cor pliance` with Courify�Ordlnance N6.7549 and existing Rules and Regulations: .rY .._.. !OB ADDRESS/LOCATION----------/_6 �J ---CENSUS TRACT..____-...�-__.-4---. 6_.53.03^.---- ------ .5_c n L a...----- Owner's Name------ C_ Y'j...-=------`- `�tJ-P = ---.Phone. 3-- --- ---- Address.--- '----------- ---------------------------------------------------- - city- .. . - °- _. C � �..t? h Zip . G lR• _ _ �. , �: Contractor's Name ------------- P �.-"� ,.License Q �7G�c� one_ " } r R ) G�itlT 9�3�� Installation-will serve: w ResApar mentMouse ❑ ominerri�l ❑ Trailer Court ❑ C _Lot.Size----- s4 @.r -5-------- Number of livingunits::__-_ __7-----Number of bedrooms ter-- rba a Grinder--.-.------- �- - .T„.t.. 3 �; I � - a WatertS-upply: Public System and-name-------------: - =. . LDSandy to .Priv-Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat Loam ❑ Clay LoamHardpan❑ Adobe ❑ F.ilI M teria If y ---------------------- ---- j [Plot plan, showing size of lot, location of'system in relat n o” ells, b ,dings,etc,must_be placed on reverse side.] NEW INSTALLATION.-'"""`(No`septie 'tank"or seepag pit tM public sewer is available within 200 feet,) �.. _-- --------------------_---t'--_k__ -...._'�_.__.________ .--.._� + ----- Liquid Depth PACKAGE TREATMENT ['] ;ASEPTIC TANK'[ ] .- aterial________________.-___.___No. Compartments p + nts-------------------------- t� + Capacity_-___r=_ " Pe t ,rte,+ -- -- " o dation ? ine . .A istance`to nearest: #__:.._Foundation..--- --------------------- un - Prof. L F LEACHING LINE= [ No, of,Line -----=------- - -- ----Length of eoch'Iino..-:- _ ' a - ----^�` Total Length._---: :------ - - r ..- - D e Filt ial--- -------Depth Filter Material-------------------------- ------: --------------------------------- 4 ---=------------------- - Distan eto ne ell-- - --------- _-----Foundation----------=-------------= Property Line--: r SEEPAGE PIT [ ] Depth------------ --- i me# ------ ------Number--.=------:---.- --. : Rock Filled Yes ❑ No❑ Wze-------=-- ------------------------------------ Dep -Y -ater Table -- Rock Si t stance to nearest: ell --------------- ------- = Foundation Prop. Line..: ------- REPAIR/ADDITION (Prev,S ,itation Perm' #---------------------------------- ------ ---- ate----r-_--------------------------- --=------- ] OSeptic Tank (Specify Requireme s)-- ------------ t------_ -- -------------------- ----- -----•- - ---`��-----�'�--'"'�----------------- ---- --- .Disposal Field (Specify Requirements)' ------- �- b-- ----------------------------------------------------- - ----------------------------- 4_1------------- --- --� ... i ---- ----- --- ----- (Draw existing and required addition on reverse side) I hereby certify-•that=l 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 r licensed agents signature certifies the following: i "I certify that' in t e performance of the'Work for which this permit is issued, I shall not einploy a y perso in such manner as ( to become .subie to Workman's Compensation laws of California." - Signed.:.. = --------------------;Owner + BY---------- ------ Title. --- - (if other than owner) f OR-DEP.ARTMENT USE ONLY' APPLICATION ACCEPTED BY--.---- -= DATE. ---------- -.----- DIVISION OF LAND NUMBER------------- ----------------------- -- ------------ ------- DATE-:__. ADDITIONALCOMMENTS-------------------- ----- -- --- :---------------------------------------- ---------------- ,. -- - i ---------------- ----------------------------------------------- - ------------------------ ------------ ---=-------------------- ---------------- ----- ---- -------------- ------ ----------- - ----------------- --- I Finaljnspecfion by _ ..gin- - �-_:: _--- --- Date. -=� - --------------------- --.. EH 13-24 SAN JOAQUIN_LOCAL HEALTH D T'ICT / 1677 REV. 7/76 3M