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FOR OFFICE USE: •» APPLICATION FOR SANITATION PE ,..............•-----. -- .--------- —/� {Complete In Triplicate) Permit No. ._7:7.._.__..__. - . _ k - ............_._.... . . ................. This PermitE)ipires 1 Year From Date issued to Issued .:�.:�/S'.77 Application is hereby made to the San Joaquin Local Health District for a permit to conitruct 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 �I �'�`�`'� -.. ..... ............................ CENSUS TRACT ........... .........•...... Owner's Name ............ .... ...............•--.. . ...........,-..•................:........_.......Phone .��6Y'1..�7f;7 Address . .............. .. . ��/ p._ . city Contractor's Nome .............. ..... ...• -- . ._... .... ? __•_._ license # a�f: ._... Phone A `~f v.�..�.... installation will serve: Residence FlApartment House] Commercial QTroller Court r] Motel ❑Other r Number of living units:..._' : Num.ber of bedrooms ....Garbage Grinder S€xe .... ..x.14. .................... �� Water Supply: Public System and name .:Private ❑ .................. .._. ............................ Character of soil to a depth of 3 feet: Sand[] Silt❑ Clay ❑ Peat❑ Sandy Loam C] Gay loam ❑ Hardpan❑ Adobe:,4 Fill Material ............ if yes,type ............... .... (Plot pian, showing size of lot, locatiori 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,) 1f ' PACKAGE TREATMENT ( ] SEPTIC TANK ize._. �X. �........ ....x Liqu€d. Depth -� . s Capacity Type Material.��7 No. Compartments ..: .........y� Distance.to nearest: Well ............ ......•�.___.-......Foundation ../O.'Y.`........ Prop. Line ...5 � LEACHING LINE No. o#.Lines _..--f-------: ...._ Length of each line.._.._!'fip............. Total Length ..1��.................� 'D' Sox ............ Type Filter Mseterial'•:....... .......Depth Filter Material ... ................. Distance to nearest: Well ............. .......:.. Foundation ./0..._f`.......... Property Line ..S................... P SEEPAGE PIT T� Depth .__. -. -------- Diameter ., ....... .._ Number ..--•-�........... ........ Rock Filled Yes No ❑ Water Table Depth --- -___ ............__Rock Size k./I 1 r I v .r Distance to nearest: Well ...................:.............-------foundation _l Z�..rf..... Prop tine . .:...... REPAIR/ADDITIONIPrev. Sanitation Permits Date —Septic Tank (Specify Requirements) ...=--- -. :.--•- �----� `----- Disposal Field (Specify Requirements).�: -•--- --------------------------------------------------------- �. - - -----------------•--------------------•----------------------- -------------- -----•--- ---...................................... (Draw existing-and required addition on reverse side) . I hereby certify that I have prepared this application'and,that'the:work will-be-doriv-in accordance with San Joaquin County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health:District. Home owner or !sten- � sed agents signature certifies the following: W "I certify that in the performance of the work for which this:permit is issued, I shall not.emplay any person in such Manner' as to become subject to Workman's Compensation laws of California." Signed __T z �. -w._ - wner O ._ - k By ---•-.•--. .. ----•-- (If other tha*,, r) .title __...__...- .-. FOR:.DEPARTMENT- _ . USEONLY _ I ED8Y -- -- -- - -------------•-•---..._.__..---- -.._ _. DATE,.._..,.. . BULLRING PERMIT ISSUED _ -----------•_...---•---------------�------------------._....._..._._.. _..DATE - -------._.... ..:... . .. , APPLICATION ACCEPTADDITIONAL COMMENTS .......... .......°--------------------------•-_-- ----------- ......... ..................... ------------ incl Inspection by: .... --------------•-•-•-•----___---..._---...._.._-.-.- .__....Date ...�'F... • •• --- EH 13 21, 1-613 13ev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7a 3M L..if`•" 3