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FOR OFFICE USE: - ` � FOR OFFICE USE: APPLICATION.FOR SANITATION PERMIT -------- ------� -------_----- ----- ------ - Permit No ��- 63-3 J {Complete in Triplicate] '! ,{ Date Issued.__- .=_72_ 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-- 2� L� _ 0. ------- Q�'�/ € ' j ` _.CENSU .Ti2ACT�ia+ Owner's Name . f �_..._. f�-�.....d�.L} v -------------------------------- -. ` Phone J' T /l � Address-- � 10?4mp< ,f! -,Y� ' --------City Contractor's Name----- (� ---------------License.# - ho a ---- ----- - Installation will,serve:" Residence ❑ Apartment House Comm rcial ❑ Trailer Court- I r . Motel ❑ Other------ __. g �----- /1 g =------ '---- ------------------ jam:Number.of livin units:_____ Number of bedrooms _ ___.Garbe a Grinder_. : Lot Size Supply: Public System and.name = ------- :.- ----------------------- - - t - ----------- WaterPrivate ❑` Character of soil to a depth of 3 feet: Sand ❑ Silt ElClay El ; Peat E] Sandy Loam ❑s Clay Loam,❑ 7� i Hardpan ❑ Adobe ❑ Fill Material---- - If ye's, type---' -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on�rev'� se side.) NEW INSTALLATION:- '(No- septic tank 'or seepage .pit permitted if public sewer is available within 2 fe60 PACKAGE TREATMENT ['] SEPTIC TANK Size_--- -": $ . ['] ` -- -` - - .q Depth._ Capacity--- =- =----Type:------------------------Material------------a------------ - No�Compar# tments = Distance to nearest:.Well-_-- -- _:.___�_-_-_ Foundation _________ __ _____ :Prop. Cine_;. LEACHING LINE [ ] No., of Lines---------------------- Length of each line_-` --------- -------------Total Length- ---------------------------------- 'D' ,. _- -----------------------'D' Box---------.--Type F1 Iter Material--------------------Depth Filter Material_._ - ------ - --- _-- ------ , --- ---.` _.. ,Foundation----------- ---- ----- -.Pro �. Distance.to nearest: Well------------------- - perty, Line SEEPAGE . ., , 4 - c ... .n 't P PIT ['] Depth_._ .__ Diameter.'_ _Number Rock Filled Yes ❑ No $ Water Table Deph - Rock Size---------------------------- -4 � . .�----: -`Distance:to nearest:Well----------- ------ ----- --- Foundafion : R: - : __._A_-' .P-r-op"-.--1Line------------------------------- .41 -------------- ----- -. REPAIR/ADDITIONPrev:Sanitation Permit _ - - -_----`-----'- __--.Date__--j-- - _--------- - -------- Septic ;� Setic Tank. Specif�ReGuirements)_--- --- - /It' 1W -- P� -- . - TAI Disposal Field (Specify Requirements)----------- - -------------------------------------------------------------- - - --`------- --------------------------------------- . - q8mag, 6-jig ____ __ __________________' ___- --- _________ ----- -------- ______ ___.__-___-. ------_ _ --_ --_ _ __ __ _ ____ _-_._____._- __ _________. 7-7 ------------------ --------------- .____..__ _.__. _ _________.__ --- -._______ _____ _ ____ __ __- - _____._____._ -- --__._ ____ " (Draw existing and required addition on reverse side] , I hereby-certify that I have prepared this application and that the1work will bejdone in"decordonce Iwith San Joaquin County Ordinances,' State Laws, and Rule_s and Regulations of the San Joaqurin LocalHealth District, Home owner or licensed agents signature certifies the following: "I certify that in the performance of the work-for which this permit is issued, 1 shalt notemploy any person in such manner as to become jest to .Wor 's pensation laws of California.:" �. Signed_- ----- - -- -- --- ---- ---=---------------Owner _By-d------------------------------------------------------- ------------------------ - -- Title-----=-- -------------------------- -=- ---- ------------------- (if ---'--------- ---(If 'other than owner) FOR'D£PARTMENT E ONLY, 71 ? ""1"DATE'7"' ----- APPLICA`fIONRACCEPTED 8Y- - _ - DIVISION OF LAND NUMBER:_ F ' ------- - ------------ - DATE.------------------:----- -- ----- [ ADDITIONAL COMMENTS---- - f: jw ------------------------------------------" ----------------------- - ------------------- ------------:-- --------------- --- -- ----------------=---- --- - ------ - '- --- : - ------------------------------------------- - ------------ by -- --7 ---`Date- -------- Final lns ectio EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7/76 3M 4 .�