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FOR OFFICE USE: �S� OFFICE USE: APPLICATION FOR SANITATION PERMIT -- --------------------------------•- --- - Permit No "�.--� �. '7 (Camp in Triplicate) c - --------------------------------------------------------- ° Date Issued._/_-W 79 --•� --------------------------------------- ------ This Permit Expires l Year From Date Issued - f 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: - 6.1 vit. A r 7 CENSUS TRACT JOB ADDRESS/LOCATI �_.�, _- _ __- ----- -- ----- ----------------- Owner's Name--------------- ' '� ------------ ------- --------- ------- Address- -----Address_ i✓ "� ' - = ----- Cit Zi Y ---------------- P---------.:------------------- Contractor's Name-°=--_-- ___-- "-- u`---- < �-- ----- �.._License #._-3Z Z ----Phone------------------------- Installation.will serve: ,tw Residence Apartment House❑ Commercial ❑ {Trailer Court ❑ . T 4 u� 1. Motel F1 ,Other---- - - - r Number•of living units:---------!.____Number of bedroo s. Garbage Grinder:..,.__.,___Lot Size-----______________._.__, �__- Water Supply: Public System and name---_--------- ,.-:.-~ -•-- car --:- ------ ------------------ m ------------------- -Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat 0 Sandy Loam 25, Clay Loam [] Hardpan ❑ Adobe ❑ kill Materia!_..--;.------If ye"s, type____------------------------- 1 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. .must be placed on revers side.) NEW INSTALLATION: INo' seAtc tank or [ _e ge __P it P:eSrimze�i t�teld�'if public sewer r is_a.v--a--ilab.le within 200fDit _ �PACKAGE TREATMENT SEPTIC TANK " Liquid ePti-- --=-- -------- � --- Capacity # -- ____-Type Compartments-,---.. �-- --- ---��i _ Qistonce to nearest:.Well----- ----- =-----�a-t--------=- ------Foundation-----t-�-------=--- --=Prop. Line-tel----------------------C3�, LEACHING LINE, ] N . of Lines.-__ _y _ "-.-.Length of each line.______. _ ______------Total' Length ----2 __, _ �} ] I .'Q Box._ (____Type,Filter Material__ -S--/Z,-,--Depth Filter Material __' .......... , ,------------+ - ""'r' r `Distanca."to nearest?Well L Q ... .Foundation__-___ - Property Line.s:.__`Jr SEEPAGE PIT �{ ] Depth--._' ..-:__-.Dia eter_'------------------Number---_______:______------------ : Rock Filled Yes ❑ NoL -. i. F JA> Water Table.Depth'-- -------------- -- --.Rock +Size----- - W:- 4 "Distance fo-nearest::Well --=------=------=------Foundation---.-------- ------ --":Prop, L ne--,----- ---- --------- -`^C t ' bote ;.... �. p ISS ecif R . u+rerjients :- ---�^�� - ----------- ----- -------- = --------------- Se 1 Se tic To ITION (Prev. Sanitation Permit� __-_�__*_��_._ _�_____.��_. - ----------------- Disposal Field (Specify;Requirements) --- ------------ -------- ---- ------------------ - -------- ------------------- ----- - -- ---. - --- -t --------------- - - .t I --—(Draw existing aAd required addifivn on reverse side). I I hereby certify that 1-have-prepared this-opplic'uNan--and-that,the-work-will-be—done in accordance with San Joaquin County Ordinances, State Laws; and Rules:and Regulation of,,,the, San Joaquin Local Health District, Home owner or licensed agents signature certifies the following: ` "i certify-that in the performance of'the work fob which this permit'is:.issued, 11 shall not a ner as to become subject to Workman's Compensation i.laws .of. California. . . . g• -- --- 5i ned- ----=----- ---- r ` ► e _ - � Ow n e� BY --------------------= ----- u 3 �979 - , t Title +3 x (If other owner) '. r ..,._,.°.FO EPARTMENT USE ONLY -�'" $AN'JOA U1N OCAL------------------ a APPLICATION ACCEPTED BY = �PV ------------------------------ -"---------='--'----------- DA DIVISION OF LAND NUMBER. = '--- :. . = QATE. --- --- ------------ ------------' - ADDITIONAL COMMENTS -- -- ----------- ----- ----------------------- ----=---- ------ ---- --------------------- ' ------------------------------- ---- ---- - � ---. ------.-------------:- --------- ------------------------------=----------- --1---- -------- ---------------------------- ---- --- --------- -- ----------------- - -------- ------ ------------- -------------------=--------------------- ------- -------------- -------------------------- ------ . . ----------------------------------------- ------------------ "--- ---------------- ----- - - ---- ------------------------------------------------------------------------------- Dte. ------ -------- Final dnsection --- FH e" '3 24SAN JOAQUIN LOCAL HEALTH DISTRICT Fes scan eEv, 7176 3M