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s FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT k%------------------------------------- --- Permit (Complete in Triplicate) --------------------------------------------------------- Date Issued_r�' - 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----------- --- � d-1 -5------ 1-5C_0_ ----CENSUS TRACTr� Owner's Name----------- 4 %` Gt. - Phone � � Address---------------------Sl }1s4 ' -- ------------- ---- ---- - -------------------- -- CitY .G ¢ -� zip---_ ,.. Contractor's Name- �141�-/ ---------------�--------- -----------License � oP- Phone- p. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ " Motel ❑ Other--------------- - Number of living grits:-___ -----_F._Number.of bedrooms.---Garbage Grinder------------Lot Size__------------ ------------------------__.______ -- Water Supply: Public System and name---- ----------------------------------------------------- ------------------------------ ---- ------------ ---Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material-------_----If yes, type_______________ _ (Plot plan, showing size of lot, location of system in,relation to wells, buildings, etc. must be placed on reverse side.) p, NEW INSTALLATION: -(No septic tank or seepage�it permitted if public sewer'is available within 260 feet,] /' PACKAGE TREATMENT [ ] PTIC TANK [ ] e. ---------------------- Depth.._-......................... + e_ Capaci y ---A----- --- -TYPe --- --------Material--------------- - ----- --No. Compartments + Distance to nearest: Wa11 AI6_ _______________________-:-Found�'tion---rrOP_�_________._ Prop. Line_ LEACHING LINE [ ] ` No, of Lines-----a-_________________Length"of each line. ' -------------Total Length._.___C-----:-- ,�l l �� ------------------------ f 'D' Box -----__-Type Filter MateriaLIAA._ld6epth Filter Materia_-_ �__________________ _ -------------------------- Distance to nearest: V(lell__�_ L Foundation. ______________Property Line__ __ __ mx;EWFI [ ] Depth_./F//-.___Diameter_V_ ___XV/1/Number--. _---- .-.._- Rock Filled Yes�-- No ❑ Ft &,07/5 Water Table Depth--- --- --------------- ------- ------------------------.Rock Size------------------------ ---------------------- Distance to nearest: Well. _----'_ -.___-_---Foundation------------------------_.Prop. Line- - �, ) ----------------- ------- REPAIR/ADDITION (Prev. Sanitation Permit#__ __ __._._.______________________.-_-- -_--.-Date"[� -------- SepticTank (Specify Requirementsl------------------F------------------------- -------------------------- --------------------------------- ---- --------------------- Disposal Field (Specify�Requirements)-------------{ i ]_______________._________________ ------ ------------------3----------------" -- --------------------------------- ------ -------------- (Drava�-existing and required addition on reverse side] .. I hereby certify that I have prepared tthis v*j pia ion and-that the-work will done in-alcordance with San Joa i „r,,.,�� q h County Ordinances, State Laws, and Rules!and Regulations of the San Joaquin Local Health District. Home owner or licensecf'ay,ents signature certifies the following:-' i x "I certify that in the p rformaeice. ofthework for which this permit is issued, I shall not employ any person in such manner as to become subject rkm Compensation laws of California." A Signed---�.'. - E --------------------------------------------Owner � t By-------------------- --- ------ -------I------------ Title----------------------------------- i (I.f other than owner) ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- • -- ------ --- -- - -- -------- ------------- -- ---- ---DATE � a----...... ------------------------------ DIVISION OF LAND NUMBER - ------------------------DATE-------------------- '-------- --- ----- ------- ADDITIONAL COMMENTS tCOMMENTS_ - -- - -- _. ---------- - _ . _ . ----------- --- } b ------------------------------------- - -- -- --------------------- ----------------------- --------------------------------------�------------------------------------- Final Inspection bY-------------�------ -------------------------------------- ----------------------------------Date.----- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fes lien nv. 7/76 3M