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ii FOR OFFICE= E: �' FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 1�------------------ ---- // ___-._, (Complete,in Triplicate) Permit No�f�.-��_7 -- 1V7;7 e i s,e Kz.. ___________________________________________ 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. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION__._ �7__ S - - __ - _---------.CENSUS TRACT..----------------------------- Owner s Name .- - ---� - Phone-------------------------------------- ZZ-1 - --- -------- --------e---- F �. Address ------ r'� � ��;� --a City_. -- _ ---------------zip ------- --------------------- 7_9 Contractor sName__°_-.- t? _ _ ' -- - - �-`--=--� -- �-/---"" --:- -.- "'License #.a��l.�-.�� Phone.��--------- - -- Installation will serve: ; Residence`; Apartment House.❑ Commercial ❑ Trailer Court El •. Nus--- ' bed' E] Other ,.. _...._. , b. . :. Motel___ r' y g ! S � 4 } Number of living units:_ ! "_ __Garbo e Grinder _.__.__:.Lot.Size ----------------------------------------- F g � ! s i nd name Chars ter of sop to destth of:3 feet: Sand �5'It.-----Gc1---------------=------- = --\--------;:-:----�---------------------------------------------------Private PP Y= Y p ❑ ❑ Clay ❑ Peat ❑ Sandy Loam ❑ }Clay Loam ❑ j Hardpan'❑ . Adobe)jr)Fill Materia ------ yes, type_.._.___ ..Y_____- (Plot plan, showing size of lot; location of system in relation to,wells, buildings,!etc.'must be placed on reverse side.) NEW INSTALLATION: (No septic tank or`seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] 'SEPTIC TANK ('j Size----- ----- �- --------- ---Liquid Depth.--------------------- --- -No: Compartments_: : Ca acit -�----�T e ----------MateriaF------------------------- --------------------:----------- LEACHING LINE i Na. o ce]to nearest: Wel.l._-------- ----------------------Foundation--:------------ ---------Prop. Lire.---------------------- --- I l Do. of Lines ----- - :--- Len.g'th of each line ----- --------------- -------.Total' Length.---------:----_------------------------ I 4 1 'D' Box_---------Type-Filter Material.------ ------ Depth Filter Material--,--------`------------------------------------------------------ a ----- --------------- --------------- F � l .. . �,. . ... .. ._. . . ,„. � to nearet: Well --_____.Foundation_- ------------------Property Lin ---------------------------------- .Distance SEEPAGE PIT [ ] Depth'__._-------------- Diameter - _- Number -- ___-_ Rock Filled Yes ❑ No ❑ . 1. ... Water Table Depth nce.to ---------------------------------------------Rock Size_-- ---=------F-------------------------------- ' ! Dista' i i i! t nearest: Well ----------------------------- --------.Foundation--=-------------_------- Prop. Line------------------------------ REPAIR/ADDITION ----- -- ---------------REPAIR/ADDITION (Prev. Sanitation Permit#______________ --------------------- ---------Date._...__..____--------------it ) I €: Septic Tank (Specify Requirements)------- -----=-------------- = # - - ------------------------------------ --- - -- Disposal Field (Specify Requirements) --- ------- - _X lE ; `- -----=--------------------= , - ---------=-------------------=------=- ------------- ------------------- (Draw existing and required addition on reverse side) I F ! t I hereby certify that I.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 or licensed agents signature certifies the following: "I certify that in the performpnce of the work for which this permit is issued, :l shall not employ any person in such manner as to become su to Workm Compensation laws-of California.” Signed ---- ---Owner v B If other than owne ._ i i Y : T1#e_._._ FOR DEPARTMENT USE LY' APPLICATION ACCEPTED BY_ ` ---------- --- --- - DATE. Q�`v`�9-7 - - ------------------- -- - ---- - -- - ---- DIVISION OF LAND NUMBER*_------ - - - ------------:--------- DATE---------------- = --------------------- ._ ADDITIONAL COMMENTS----- :!:--_.-____. -------------------------------------------------•--- ------ ---------- -------------- --- - ---------------------------------- =�=�"=AF7�� . _ _._ --------- - -- -- -- ---- ------ ------ --- --- --- ------------ ------ ------------ ----- -- ------------- ------ --------- - - P Y: _ ----------------- ---------------------- --- - p -- - -- ---- =- - ---- Ddte/�--- r . ------------ EHFina Inspection EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M