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FOR OFFICE USE: FOR OFFICE~ USE: APPLICATION FOR SANITATION PERMIT 9 (Complete in Triplicate) Permit N -J'- ...... ................................ .................... This Permit Expires 1 Year From Date Issued 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.--. �"s .. ---- ----- -------------------------------------CENSUS TRACT------------------------------ Owner's Name.... ......... (/ ........... Address. .. Y C .Zi Pt Contractor's Name................ . License #_34-31-91. .Phone_.lif�. .a�t- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel F1Other__....... .. ...-........_... r Number of living units:-- ....Number of bedrooms..... Garbage Grinder------------Lot Size.....�d.,lC/'? ......... Water Supply: Public System and name.-._ .. __ .�, -- l.L�.Q, ,.------ ❑ . . ..-------•--- -- ---------�-�------------------------••----.Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam [] Clay loam ❑ Hardpan ❑ Adobe >r 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if ptiblicpwer i available within 200 feet,) `/ f PACKAGE TREATMENT X,S-x - _Liquid Depth.--.f J SEPTIC TANK /t� Size.......��.� ... �... . .... Capacity.. Q.[]---Type- i _ Material ' .--,--.-No. Compartments..-----.:.-a------...-.�----- r Distance to nearest: Well..... ----._...Foundation-./4. ......... ...Prop. Line..- LEACHING LINE [ No. of Lines _/----- f --------------Length of each line.--�O.,Q..-..._.-..... Total Length .. r4.f�....---.------ ------- D' 13ox_........ ..Type Filter Material.`.....a4oepth Filter Material...... .....---.._.........................�.. Distance to nearest: WelL_. Y �_._.Foundation__��.r............Property Line_--Jam---./... ------ r Sf-E41>6S6E-PE�* Depth...- -a-....Diameter.a--,X/0--Number... e r/ Rock Filled YesX No ❑� Water Table Depth---------- ------ -------------------------Rock Size.-- ..................... ...... . rn, I J Distance to nearest: Well------------ ------Foundation----�1_1�7.............Prop. Line.--.',---------- ---- -- REPAIR/ADDITION (Prev. Sanitation Permit#---.-.-----•--.•------------------- ---------------Date---.------------..----------------------------) -� Septic Tank (Specify Requirements)--- . ------ -- ------- -----G Disposal Field (Specify Requirements)------------------ -------•------------------------- --------Q --- --- -------------------- ----....---Q+ ...................................................... -----------=----------------.....--- --------------------------------------------------- - - ------ - -------------------------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and 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 following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become sub) W/ rkma}nI Com ensation Iaws of California." Signed- -rrF�-B-a -C, ------ - ---------- Owner By..--•----------------- -ta * ----------.....Title.... ........ other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- - L.�- ---��- Z---.......- •- ---------------------------DATE DIVISION OF LAND NUMBER------------------- - ---------------. .. - DATE..................------ ADDITIONAL C M EN S --... _... ._ . :: ::: : : ::: :.: ....------ -------- ............ : .. . . ---------------- -------- ---------------- -- _)� Final Enspeetian b �D t Y' -------------- - `! E" 13 24 `�� SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M