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V _ .a.._�-f�-..-____ 1 FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ,q F (Complete in Triplicate) Permit No g�_r�__ - j - Date Issued-/0--b?--,,7-9' ssued_/0_1?_=�9' ---------------------------------- ----------------__-- 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. t This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -_ -- D '---- ------ - --- ` CENSUS TRACT---,---: . - - Owner's Name` --- ,---- --- ------- --- :- - Phone--? R---7-------5----- -- - Address - - - - City - zip Contractor's Name _ __ _ __ ____ _ --------------- --------- ---------- `_License # � _ 3`__Phone--7 _L_---- Installation;will serve: ; Residence Apartment House ❑ Commercial ❑ Trailer Court 8 ctel-n--,-Other--------- -------------------- i_ _. , t Number of living units:_ Number..of...bedrooms`------------Garbage Grinder.._ :.Lot Sizeb r _ f ------ ---------- Water Supply: Public System•and name ,_. ---------------------------------------------------_ Private ❑ Character of soil to .a depth of-3 feet: : Sand E,-•-•-Si•It•E--Clay❑ Peat D—Sand Loam- C-Ia Loam trdrndpa 0;, Ad be`[ ' Fill Material------------If yes, type--------------------------------- Y ___ _____ _ (Plotan,p Ishowing, ze of lot, location of,system ,in relati•on--to-w-e-Iis;`b`uii.dings etc must be placed on reverse side.) �--+ s.i NEW INSTALLATION:`" (No";septic tank o seepage pit permitted'if public sewer is available-within"200 feet,) S PACKAGE TREATMENT [ ] # SEPTIC:TANK _ ---- { {. ] Size_ o ] ---Liquid Depth - -- ----------� w t Ca acit == ------ --Mater i_,. i— ..... .1 .�!? : Y - ---- YP ------ --s- �.a] --- :- --No.•Compartments-------- ----------------- 'Poo- ----- -------:--- 6``` to.nearest:.��VeIL:__ ______ . .__ �~Foun°dation- _ _ Prop Line { ` LEACHING LINE ['] No. of�L Vines_.= _Lengthsof each Line ___ _ Total Length }D'= Box "'_Type FIter Material Depth Filter Material _ I Distance to nearest Well Foundation__ s Property Line'_ ___ ----- PDiameter-!----'_- ...,., ; . SEEPAGE PITDepth 4 [ ] De th- Diameter _ N*u er _ __ Rock N Yes ❑ mb ------------- Rock Filled Y s o Water Table;Depth ) -- Rolck `Si'za - _--- -- --- --kti ;. Distance to nearest:Weil _Foundation _ _.Prop. Line---J ,y REPAIR/ADDITION (Prev. Sanitation Permit# _ Date ; _ ' ) t Septic Tank (Specify Requirements)— r- v to .. .>l Disposal Field (Specify Requi err`lents)Y� �.. / Q. - j ,. -----------------------------~ - -- ' - - -- --- --- - �...... -'.ter .. , ... •: • -.• � - .� .. �.� f- _____ _ F } �.:----"(Draw existing and required-addtion-on�r"averse side} k hereby certify that I have prepared this application and that the work will be done in•-accordianc''e with San Joaquin County" Ordinances, State Laws and Rules and Regulations of`the Sari Joaquin Local Health District, Hofine owner or.licensed agents signature certifies the following "1 certifythat in the !{ performance of the"work for which this perrrnt`is, issued; I shall not employ any person in such manner as to become subjectwto Workman;s Compensation'..laws.of...Calforria�' _.; Signed----------------- Owner t i . t BY i -- - --- fi Title .. . _ .� .. e y Cher than' wner1...) •o ' a F9d D ARTME U E ONLY , APPLICATION ACCEPTED' BY -- = DATE DIVISION OF LAND NUMBER- ---- ----- - - ` - `---DATE --------- ADDITIONAL COM .., MENTS ---- ----------------------- -- - - A ------ ----- ----------------------------------------------------------------- ------------------------------------, - - - Final Inspection by - - 4-- (s._ -__ -: --- -_ __ ---- - Date_ �C��P:�7 eH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 REV. 7/76 3M