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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT '` --------------------------------------- Permit No..7_�_-/T3 {Complete in Triplicate) ----------- --- 7� i Date Issued._......"-- --____ ---___ ------"------------- 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. 544 and existing Rules and Regulations: l , + ,p ----- --:---CENSUS TRACT.-.---'---- ----------------------- --------- ---------- JOB ADDRESS/LOCATION�2-.�,�D_. . _„-6 `�'��-y=`�=-'---- ---=------- - --------.. ' Owner's Name -- Phone - ., .-...-.,...-r Address --... ---- --------- •------ �..� ,-,. ----- -- --- - -_'� -----.. Ci`tY- ---. ... .._�-�;--Z-iP---.-_ -.--- -------- --- ._. Contractor's Name._'Lir ..,^~._. "�-� :-=--- - � , fLPhone ', _ License #_ Installation will serve: esidence Apartment House.❑ Commercial ❑ Trailer Court [] Motel - ------------- 9 --- --- - � '---- ,_ ❑ Other -------�1- ---------, .�s Number,of,living units. ___-...__,Number of.bedrooms .�T---..Garbage Grinder.._.___ _ `-L-ot,Size-------- ��*-�. I--- Water Supply: Public System and name ] ------ — ----- --- =--Private Character of soil to a depth of 3�feet Sand ❑ Silt ❑ Clay ❑ . Peat ❑ 5andyLoam ❑� Clay Loam ' Hardpan ❑ 7 Adobe VIII Material-.. ., If yes, type......,---------------------- i (Plot plan, showing size of lot, location of system in relation to wells, buildings,-etc, must be placed on reverse side.) a NEW INSTALLATION: [No.septic tank or'seepage pit permitted if public sewer is available within 200 feet,] #. 41 PACKAGE TREATMENT ( ] SEPTIC TANK ] Size-----_-3----`------------•-----------------------" -----------Liquid Depth CapalcitYl- YPe :Material- -1-----' :-No. Compartments------` ------------------ Distance to nearest: Well- ---- ----- Foundation-`-_ == Prop. Line ' 01 # -. �? ;.- g { line-_'741E :i . ..--$----:-Total.L ngth.._'1-_.. �- - ------------------ ------------- ------- ------ LEACHING LINE [.] No. of Lines..; -__-_- :. . . _ Len th o . I B'ox..!.._ Type Filter Material ---Dept h Filter Material__-------------------------------- --------------- D, ----e _r ` Distance•to nearest: Well y Foundation--- _.Property Line-------- W .- ._ ion--- Number _.- Rock Filled Yes No SEEPAGE PIT [ ] Depth -----..Diameter .- --- ❑ i ] Water Table Depth--- -=------=-- ---------------------------------Rock Size_----- ------=------;-------------------- E } Distance to nearest: Well ------------- ] '*, ; ----"� REPAIR/ADDITION (Prev. Sarii ation Permit#--------------------------- -- �,-----yDatedati' :...- _-- p` ' p. ] on_ = . ro Line e Septic Tank [Specify Requirements].-_-- --=--- --=--`----=------ ----- ---------------------------------- - -- 1 k ] ----------- -' -. I Disposal Field [Specify Requirements):-- _ �--- ---'- -. -'------- --�---------------- -- - ---=--- --- ------------------------------------ - - a work one in accordance with San Joaquin (brave existing and required addition`on reverse side) # �y -------------------------------- 1 hereby certify that I have-prepared this application and that therk will -bey d dCounty Ordinances, State Laws; and Rules and Regulations of'the San Joaquin Local Heaith District, Home owner or licensed agents signature certifies the following "I certify that in the performance of ahe work for which this permit is issued, I shall of employ any person in such manner as to become subjectSWork;m�an�'sompensdtion Iawsof�Califocnia.” Signed ! - '-- - Ownar .; i I . . BY =- Ti le; - t - t Ilf othertthan`owner) F i FOR DEPARTMENT USE ONLY `{ { APPLICATION ACCI=PTED BY. ..__ _ --DATE.___- DIVISION OF LAND NUMBER.. ---------- --- - = _ .= TE ; F = ADDITIONALCOMMENTS---------=----------------------------=-----------------------------------------------------------------------Dla----- ---- --F------ ------ ;---------- --- _ --------------------- ---------------- --------- ----- ------------ ---------=------------ -- ------------------------- ---------------------- _ ------------------------------ ----- ---- --------------=------ ------------ ---------------------------=- � - - - ------- - FinaI2Ins ection b -AN JOA UIN LOCAL HEAL �-'Date=�..`��'� _ S Q HEALTH DISTRICT Fac 21677 aEv. 7/76 3M