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FOR OFFICE USE: AJL, 7-0 FOR OFFICE USE: APPLICATION FOR SANITATION PERMITOe S .e �_�� ----------- ----------------------------- (Complete in Triplicate] - - /3— lsermit No. - - ------- 4 r Date Issued_-_ -f' __________________________ 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----- _._�U -.- -------------- - --------------- TR CT - � - hF =Owner's Name--------OP^ "q--�-v---- Address--- ------ -�-- -------------------'------- ------ - --------------------------City --------------- -------zip---l�S - - ------- Contractor's Name----- Al---- ------- ---------------------=---------------------License #--- ----- ,- ------ -------Phone-------- _-------- Installation will serve: Residence EK Apartment House L] Commercial ❑ Trailer_Court ❑ i Motel ❑ Other---`------------_ Number of living units;----------------Number of bedrooms----.73 _.__Garbage Grinder------------Lot Size------ le - t+ - • f � --------------------------------------------F 'I Water Supply: Public System and name------------------------------------------------ ----------------------------- Private ❑ s 1 Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑' Sandy Loam ❑ TClay Loam ❑ Hardpan ❑ Adobe❑ Fill Material------------If yes, type-------------------------------- 1 (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,�f public sewer is available within 200 feet,) " PACKAGE TREATMENT [ ] SEPTIC TANK [ ] x�S S1iellT�N✓___---__- _ . ---------------- - Liquid Depth Capacity__ 77/ ^�t YPe Material �_ -Via•-__-`_No. Compartments-------- -------------------------- 4 Distance to nearest: Well.------------------------------------ -__-Foundation--= -- y.--------Prop. Line---------------------------. No. of Linesi_ - -F ------ r : 0 LEACHING LINE [ I' - ` --_,-__-`_ .Length of.each line . C ______ Total Length.____.__, _-_____-., 'D' Box - -------Type Filter MatericgL ----------------Depth Filter Mat efria l----------------:---------- ---- ------------------- Distance ------- --.Distance to nearest: � Well__5Q__,_Pd �( tound_ a_tionY�- Q------`4---_...__._- r _-- _-.Propertyine SPIT Depth./ Diameter__1x.___ mer___ _- -__- -- Rock Filled Ye�, No Ej Water Table Depth------" t� , --------------------------------Rock:5ize S Distance to nearest: Well------------------------------------- ---.Foundation--------------------------.Prop. Line---------- -------------.._ REPAIR/ADDITION (Prev. Sanitation Permit#_O ' _ - - _ - -l------------------------Date--- --------------_- --- --------- 40 Septic Tank (Specify Requirements[-------- � --=--- =-------------- --. ` G X Disposal Field (Specify Requirements]---- 7 ------------ -- ----------------- -------- --- ------------ - ---------------------------------------------------------- --- ---- '_ -- - --- (Draw existing and required addition on re..verse side) w• I hereby certify that I have prepared.this'application and that the'work-will lie'done-in accordance with San Joaquin Coun► Ordinances, State Laws, and Rules and Regulations of the. San Joaquin Local Health District, Home owner or licensed agents " signature certifies the following: r4 "I certify that in the performance "pe for which this permit is issued, .l shall not employ any person in such manner as to become ] to lA�orkman5iyn laws of,California." Signed - �. `�f ----------- ---------f--------------------- ......... f i BY----- --- ------------------------------------------------------------- --------- ------Title-----------=-------------------- -----=------------ --------'------ ° (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ = - = ------ -------------- -----DATE - 7 DIVISION OF LAND NUMBER. = -------------:.--.------`---DATE ----------------------------------------------- ADDITIONALCOMMENTS------------------------- ------------------------------------------=-- ---- --------------------- ------------------------------ ----------------_------- --- --------------------=------------ -------- --------------------------------------------------------=----- ---------------- =------------------------ --------- . -------------------------------------------------------- ---------- ----------------------`---------------------- Final Inspection by - ---------------------------- -- ----------------------- Date 1- � 7 EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICTF&S 21677 REV. 7/76 3M C`�'M'J.