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FOR OFFICE USE: FOR OFFICE USE: A APPLICATION FOR SANITATION PERMIT r 1 Permit No._7- -------------------- -- � [Complete in Triplicate} ---------------- ------=------------------------------- Date Issued._--,�2/--79 _______________________ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Heafth�Distr.idt fo'r-a-permit,to construct and install the work herein described. This application -is made in -com°pliance-with-County-Ordimnce N6-549 and existing-Rules and-Regulations--- . �I CENSUS TRACT.... ----------- JOB ADDRESS/LOCATION Name. "v C�� --------------- ----------- Owner's _ = - ---- }ja;z -7 Phone ___ ----------- ---.._City'- Address ��- ZAP Contractor's Name----- License # h'z — _Phone t - - Installation will serve: �. Residence Apartment House.❑ `, .Commercial ❑ Trailer Court ❑ 1 ,. Motel 1]' Other._. . 'rn) -------------- ---------- ' _ I , Number of living units:--:__-L---_____Number of beds room --.Garbage Grinde•r---__.__._--Lot Size_,- --.-_ _ --------- -------- --- 7 M � I rkVate Water Supply: Public System and name-----:- .; --------- ------------------ ------------- :.. -- Character of soil to a depth of 3 feet: Sand ❑ zSilt❑ Clay ❑ Peat 0. Sandy Loam ❑ Clay Loam 0 - _ Hardpan Adobe ❑ Fill Material_- ------.-_lf yes, type_________________________________ 4 (Plot plan, showing •size of lot, location of system in relation to°wells, buildings, etc. must be placed on reverse side.) LM NEW INSTALLATION-- (No•septic tank or se age pit permitted if public sewer-is available within 200 feet,) r µ �� .Y -"-�-- Liquid Depth-_ .. t PACKAGE TREATMENT [ ] SEPTIC TANK [rage Size------ ---/r �--------��=- q E �,, �,p� No:•Com artments--�________________.-. ` Ca acity-� P.? TYPe ------ Material.- --------- Line- Dist-ante)to nearest: Well. 1P _fes - Foundation:__ - - :Prop. Line___5114. - ----- - — - ./ r No. of Lines---_--- LEACHING L1NEL hl. .. -L--------- .-.-Length each lin&----=--�4�, --- Total' Lengthv�Q�------------- -_---- i r ` n w" t / :----Depth Filter=Material----- _-�_i' ---------------- -- D' Box_ .Type Filter Material Distance to nearest: Well__ f� .____ ' _.. Foundation __ l9� Property Line _____ ____._ e N Rock Filled Yes.�No E] SEEPAGE PIT [1� Depth - --Diameter --- Number--- SEEPAGE i t . - rS.=, Rock 1ze__�= -�� - s � Water Table Depth.--- -----�-�------------------------------------' . --- t ---------------- r ---- ----- ,.- �.. Foundation'=__ _`'©-----------.Pro Line__.--=d7--- Distance to nearest:"Well ' = - l P. ) (Prey:-Sanitation,Permit#__ _____- _--w_------------------- Date------ - --- `- `----------------------- REPAIR/ADDITION + ------------ 5eptic Tank (Specify Requirements) - ------_ - ---_r.�------- = = ------ Disposal Field (Specify Requirements)--,-----:---- ----- ----------------------------------------------------- ------------=-----`------- ------ ------------ ------ ------------- -------- ----- ---------- - -------- -- -- --_ ----- ---. ----------- --- --- .-- .-------------------- 1 ----------------------------- ---- ------------------------------------ ---------------------------------- ---------------------------=------ ----- ----------- - I (Draw existing and required addition on reverse side) .. 1 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 subject to Workman's Compensation laws of California.'.' 1Owner Signed------ ----------- ---=-------------'---------- �. e - ---------- -- Titl - - (If other than owner) -FOR`DEPARTMENT USE ONLY W - ----- -------------------- --------- ---- APPLICATION ACCEPTED BY ---DATE.-- ----- - -------- ------------- OF LAND -.---------------- -------- -------------- DIVISION DATE ADDITIONAL COMMENTS------------- ------ -------------------- -------- = --------------------------------------------- ----------------------- 4 _____________________ __________________ _--------- __.________-___.__.__.________ _. __________________________________ $ ____ ______________________________ _ ___ __- __ __________._._______.___._._.______ -- _ ____. - - ---------- D -___..___ Final Inspection,b �. ...;.. v ------ --------------.--Date--- -- ---------- F c EH 13 24 SAN JOAQLIIN YLC; L HEALTH DISTRICT F&S 21677 REV. 7/76 3M s