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FOR OFFICE USE: 0 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit(Complete in in Triplicate) --------------------- •----- - ............ Date Issued.'--0t.'7- -- ............................ 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: k JOB ADDRESS/LOCATION �zf �b SESTA. Rte...- -Srr'e c o .9....................CENSUS TRACT -----•------------ Owner's Name.. Z`.4�n? .A_VA. ... ............. �" ---- ---- -- ---•---- Phone .. ..•--/ Zip.-. -x '0.7.--- -- Address - -- $?- ..PO)D.E-S.T.A pa... ...`�' ........ City -� Contractor's Name... -`-A-t..PA e.,�l FN------le- ......... ................License #. . .Phone.4 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ r Motel ❑ Other_--- ---- ---------------•------ 1 Number of living units: ----L.--------Number of bedrooms.------- Garbage Grinder.::_-....__.Lot Size............... ----_------ - t Private Water Supply: Public System and name_ - t -------- Character of soil to a depth of 3 feet: Sand ❑ Silt 0`"Clay ❑ .Peat ❑ . Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill .Material If yes, type—.. [Plot plan, showing size of lot; location of system iri relation to`w,ells buildings, etc'must be placed on reverse side.] b4 NEW INSTALLATION: No septic tank or see a e it ermitted'if u6lic sewer is available within 2p0 feet,] ( P P g�p `P P L , f PACKAGE TREATMENT [ ] SEPTIC TANK [ ]. Sinew_..__... -- '. `- ..----Liquid Depth.........................`�. Ca acit Type = MaT Tial. =.-_..N'o Compartments-------------- -- P y--------------------- yp 1 a. [ Distance to nearest: Well.:,-- .... ----Foundation_ ---- ...Prop. "Line.-. .. ; LEACHING LINE [ ] No. of Lines ---------------------------Length of each line......-------------_..... , Total 'Length --------------....---......... - 'D' Box....=. .S pe Filter.Material__ Depth Filter Material-- ----------------- ------------ --------- Distance to nearest: Well...... ...........Foundation------------------------- -Property Line------------------ -- SEEPAG@ PIT [ ] Depth................Diameter..--------- Number._...-------�-------------- Rock Filled Yes E-] No i y. :� F Wafter Table Depth ';....'....... �';-- .Rock Size-------- ---------- ---------------------- ------. t Distance to nearest: Well------------- ------ ----------- ----;....Found ation..---.........-. .. ......Prop. Line-----.-.---------- --- REPAIR/ADDITION (Prev. Sanitation Permit#_C__ -9' - 4 .....Date_.. 9/S1�_----------------] :. Septic Tank (Specify Requirements)..... : ...! ------- ...... a r T" Disposal Field (Specify Requirements)-...A_`Ap:��'--=- L ��'�-- 1 N° `�-'S 3 X ---...p fl_IN---P--------- ......_........ ............ .......... ........... ------------------ -------- ..... ..---- -- -----............ ........._... - -..-= (Draw existing and required addition on reverse side) E 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 certifles 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 becomes Iect to W rkman's Comp n3atian laws of California." . , t ---Owner Signed--- ..aGf -_ f By-.---------- Title...�s' ---- [I other than owner) € r FjOit D PARTM T USE j9NLY APPLICATION ACCEPTED BY---------- .......... .....--- DATE DIVISION OF LAND NUMBER--- -------- ----------_ ------------ ------------- -------- ---------- ------ - ...DATE......_....-- --- ---- -- ---� ......... --- ADDITIONAL COMMENTS--------------------- - ---...-.-...... ...... -----•----------•- ---------------- - ----------- -- - - -...........-------- ------- ----- -- - --- �.................... --------- -------- -------------------- ��:_�� - --------------- Final Inspecrion b Date._._.._..... EK 13 24 SAN JOAQUIN LOCAL HE H DISTRICT F&S 21677 REV, 7/75 71V