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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------------- Permit No.7F /Dl/_ (Complete in Triplicate) --------------------------------------------------------- Date Issued_//r-4S ------------------------------ ........------------------ 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: li JOB ADDRESS/LOCATION----_- _ /07 1-_.__ 4--..--U - ,✓--------------------------------------._.,._-.CENSUS TRACT--------------------------------. Name------- ------ - �cz. _ ,aR ,*.-. - ---------------- ------------Phone-------------------------------------- Address---------------- ------------------------------------- Addess---------------- --- ---/-zl7-1Y------Sim_._. / .- -t- ------------City-J.47 ------ -- -----Zip---- -------- ----- ---------- Contractor's Name Ae4La i ` � (M------ ---.License # 28 .z Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other---------------------- ----- - Numberlof living units:------ --------Number of bedrooms.....3---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 y Adobe ❑ Fill Material--.---------If yes,type----------------------------- -- (Plot plpn, 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 public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [/J' Size_ _-----------------------Liquid Depth..__.--------------- � Capacity-/400---------Type Material--- 'k`' +------No. Compartments----- ------------------ � e ______ ._.________-_---- -_ ___________Prop. LineDistance to nearest: Well----------- Foundation.. a . -_.Total LEACHING LINE [�] No. of Lines--------..3 -------Length of each line----------4�A____ .- Length --- 1-2-0 D' Box------ ----Type Filter Material---.& --------Depth Filter Material---)4--11--------------------------------------------- - -� Distanceto nearest: Well--------/_a_4F--s__-___Foundation------ .�._�_______ Property Line.__..___S__-- 'of [�SEEPAGE PIT [ Depth.-__��.___Diameter____.__ -'of ________.___ Rock Filled Yes No Water Table Depth--------------- --------------------------------Rock Size- -3 } Distance to nearest: Well--------- ----------------------Foundation-------AA____...........Prop, Line------ REPAIR/ADDITION (Prev. Sanitation Permit#---------------------------------------------------Date---------___..______--.____.___._-------------) SepticTank (Specify Requirements)--------- ------------------------------------------------------------------------------------------------------------ Field (Specify Requirements)-------------------- - ------------------ ------------------------ ------------------------------------------------- -----------------I--------------------------------- ----------------------------------------- ----- - �j -------- ------------------------ ---------- ------------------------------------------------------ k (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 subject to Workman's Compensation laws of California." Signed--- -------------------------------- ---------------- --------Owner SY-------------------------------------------------------- ''Gt"'`e�''�<--�-�-- --------------Title.---. �---------------- ------------------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- '--`----_- - _ . DATE ��-� - ------------------------------ DIVISIONOF LAND NUMBER---- ------------------------------ ------------ ---- ------------------------------------------- ----DATE---------- ---- -------------------------------- ADDITICrNALCOMMENTS------------------------ ------------------------------------------------------------------------------- -------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------ ------------ --------- =---------- ------------------------------------------------ �• �� ✓� -------- Final Inspection by:------ C" �� --- ------------------------------------------- ------------- - Date EH 13 24, SAN JOAQUIN LOCAL HEALTH DISTRICT F85 21677 REV. 7/76 3M