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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ,77_ 691 ----------- ----- -------------------------- - (Complete in Triplicate) --------------------------------- Issued �� 7] -- ----- ---- Date -This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct:d d7nstcllPthe work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rule}ssaand Regulations: C�ra...�.. _CENSUS TRACT--------------------------- --- JO.B ADDRESS/LOCATION------ -. ------ 4.01-- `Phone til Owner's Name: t' �.. �� _ _ - i city zip Address.--- --- ---- ---- - -''� = '0 4/ � �' , s ' F,t� _ °'"�_ License - Ph ne - Contractor s hame_-_ ._s_ �-.- - ---� °--- ----- � "" � - - Installation willser- e:5; Residence Apartment House.❑ Commercial E] ;Trailer Court 0 ; x Motel• ,. ------------------------------ ---------------- -------------------- -: Munits:---- i Number of bedrooms age .,;,, .... _ Other. __=+ Garb a Grinder. T�,Size-l units Number of living. I II r ` - - ------------------ -- -- -_ _ _. � =- �----- ---- - Private Water Supply: Public Sy�S�teKns�'nd narne---------------- � 3i� -�--- .. . ;. � Characteriof soil;to a de�f11!bf._3]feet: �SarSd ❑ Silt 0 -Clay E) Peat❑ Sand oam ❑ Clay Lam `Hardpan ❑ :Adobe� Fill Material_._ ,......If yes, type --' - --- -' -- ---- (Plot plan, showing size of loth'location of,system in relation to wells, buildings, etcs must`be placed on reverse side.] �^ Ze . # , NEW INSTALLATION: ;(No septic flank'or seepage pit permitted if pub c sewer is available within 200 feet,) 41 er . PACKAGE TREATMENT C ] SEPTIC TANK... "!`. " Size '-== - 1----------'-------- Liquid De th = i - 1' Ca dcitVJ.-8:0 ------TypepA'/_.�---Material_ a7[ ---_' No. Compartments._ .. ` y } 0 ±` p 1 :Foundation.- -- ------------- --Pro Line-.- r ------------ Distance to nearest: Well_ �� p' I LE CHING LINE: No. of Lines-.- _ --;_---- - Length of each lina._.,,__ o�'� �_ - ------Total Length-___.__ .- - ------------------ y. a D' By -�- ;_Type Filter Material_, Depth Filter Material_ ,_ --------------------------------------------------- ox_ _ , • ... I __-Propert Line - ---------- `Distance to nearest: Well-<Y�_4---`--- rcr �J---- Y f �_ � ; Number�Zunclatio'n. Rock i Ye N SEEPAGE PIT �(( Depth_ ' -_ "Diameter T Filled `. / _ -- --�'--- -'3/ ------------------ f , -- .-,---.Rock Size - /C7 • Water � gble`Depth_��'>�-------------- -- --- . 1 ._: -Foundation.__ ---.-- -__.Pro Line-- ------ ----- ° t .. Qistance toy f rest -Well-_�: Q--�_-- --- �.•._"_,.�� _.._ p. . 4 REPAIR/ADDITION (Prev oJ Srmit ' - :----- - - Septic (Specify. ---------=---1 � Tank (Specify..Requirem nts]'- j' ----:..:_ = Dis _.. ---------------------------------=-----° - :---------------------- ---: I posalIField (Specify Requirements?- �---:.-•---------------- ------------------- ------------- ---------------------------------------------.. _ ------ --- -------- -- ---- ---------------- ------------------------------ - ` ------=------------ -------=--- -----=--- • --- ----- ---------- - -- -:------ = (Draw existing and iequired'addition-ori reverse side) ` I hereby certify that 1 have prepared this application cnd that the work will be done--in accordance with 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 follawing: ' "1 certify that in the performance of"the work for which this permit is.'issued, I shall not employ any person in such nianneras to becor6e subject Workman's Cnsat' ' laws of California." ... - ------- Si a i Signed_ A.-Q-`� �-� 9F • ----------------------- -- ------ BY : - . . . Titl `/4 F -.r ' '(1# other than' owner] FOR DEPARTMENT USE ONLY # �y APPLICATION ACCEPTED BY------ DATE----------------------'.----- - ----- DIvISION OF LAND NUMBER;-------------: - ------- - ADDITIONAL COMMENTS- - ---- ------------------------------ ------------------------ -- J ------- -------- ----->----------------------------------- .. . _ --------------- t { ------ --------------------------- k ---- ------- ---------------_.._ __ ___________________________ _ Final-Iris ection-b � - ---------=----=---------------Date..._--- ----' 7/76 3M FH 13 24 / SAN JO 0_ UIN LOCAL HEALTH DISTRICT Fas t 7 ev.