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Y FOR OFFICE USE: � FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------- w (Complete in Triplicate) Permit No._ 7 f` 3l ----------- '41 1-------------------- — or -_----___ This Permit Expires 1 Year From Date Issued Date lssued__6'�' 7� Application is hereby made to the San Joaquin Local Health District for a permit to construct an install the work herein e'Cs r=CLI This application is made in compliance with County Ordinance No, 549 and existing Rules and Regulations: J08 ADDRESS/LOCATION.------- :- -'--tff1G -Ad CENSUS TRACT 4 s - _i�4..... ----- _, --------------- ---_ Phone l .:. . Addres S -- F /�9 s City . ', .r� - ziA'=;- ---------- Contractor's Name �.� r �,G-- ----COX) ^� . ____--License '# _ 6 Phone -__ -_ --.' Installation will serve: . . Residence;�(" Apartment House.❑ Commercial ❑ Trailer Court'❑ t f "Motel f Other:_ - ` Number of living units;_'-- /_ _ Number of bedrooms-_ ___Garbage Grinder.,,__-_____La�ize_____: C/ jP.� Water Supply: Public_System•and name___________________.__.,_-___ -:---------_ --------- I - =z ---- - =:- ---------------- ---------------------------Private Character of soil to a depth of 3 feet: Sand ❑ .,Silt❑, Clay [:]-, Peat❑ ;Sandy:Loam Clay-Loam ❑ -Hardpan ❑ Adol:4(] . J _ �..,...., Fill Material-- -- if ygs, ----------------------- (Plot ------------------- ' - (Plot plan, showing size bf lot, location of system in relation to wells, buildings, etc..muii be placed on reverse side.) i NEW INSTALLATION: ''No septic tarik1or seepage .pit permitted if public sewer is a allable within 200 feet,) li} PACKAGE TREATMENT [ ] SEPTIC TANK jr] Size---------- �- -- Liq uid Depth.- -----------_ ---C-r?�- ' Capacity_/AQ7 �aterilCPVCA� ------ --------------pe t ' i Distance to nearest: Weil, . _. Q . ;-------------- ---_Found L ine----66 LEACHING LINE [ ] ,•,•No.:61�U'nes-„ � f . _ _,.___Length o�ach line.- ___.___ , Total Length--------� _ -_ Q6, 1 i r !I .� D' Box _____Type Filter Materiaa2.f__/Cc' Depth Filter Materiae--'_ -__--.---,,- ---- --------- '_ _ .,, . DistancB-to-nearest: WelO�; 30-- i,-- -Foundatioq;,___ _- Pro er Line -�-- P �y f� SEEPAGE PIT [ ] Depth_ . -_--- Didnieter;- - - "._Numbe�r""r ' '` r _~--17D—p r� a : ----------- ------------ ------------Rock Siie _--------------- Rock Filled ❑ �° fWate Table De th _ �„: 00 f .Di tance to near; Well = ----- - ------Foundatioon--=--------------------- Prop. .Uneni--�---------- -- - . REPAIR/ADDITION (P.rev. Sanitation Permit#_�__`:_�a__ :' � "' �, ----Date__. ------ -------------------------- Septic -- ------- "'"�) " 3 Septic Tank [Specify;k—equirements] -------fF�_ -::- Disposal Field (Specify Requirements._ __-__.s ----------------------- - ---------- ------------------- ------- --- = r � . ----- ------------ ---- ------- ----- ------ -- s _ _ - (Draw-existm and re uired addition on reverse side} 1 hereby certify that I have prepared this application and that the -work will-be done in accordance wiih .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 performdnce'of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." � x Signed----- ---- -�----- ----Owner SY Title- ----- ---------- _ f { ... .. /irk rte`' (If other than-owrier) � � '• � � SS FOR DEPARTMENT USE'ONLY APPLICATION ACCEPTED By.... __ . ---- - ------ ------- ------------------------------------------------------DA TE- - DIVISION OF LAND NUMDATE BER.---------_--- , j x ADDITIONAL COMMENTS------ ------t _ ---- -. ,-- C___--�/^ 7 s ------------------ ----- ------------- ----- --- -------------- -- -------;--------------------------=---------- - '' Final-Inspection by:- _-.: - - ''Bate -- - - --- - -------------------- EH 13 24 SAN JOA U1N LOCAL HEALTH DISTRICT F 21677 REV. 7/76 3M