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FOR-,OFFICE USE: - FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT '/ Permit __ No. a 3.- (Complete in Triplicate) .................. --..._...----......---...----- ... Date Issued.+5r4_..__'-7Y � ..........--------------------------- This Permit Expires I 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 Regulatiops: 1 JOB ADDRESS/LOCATION•16TaNFir......- ..----•--------- CENSUS TRACT.-- Owner's Nome......elf..17--./.✓6.S`_ ............ ......................... Phone-f3l:g- ............... --------- ...7 . 1/T City ._0_ ;---- =---- Contractor's Name --A.,Z, /F4,46 6 ................. - License # T-�J ..Phonellg Installation will serve: Residence �g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [3 Other------- - ---------_---------- Number ---- ---Number of living units:-1 ---------Number of bedrooms-�-.__..Garbage Grinder-------.----Lot Size------ -------- . -- - Water Supply: Public System and name-- ........ ................ -. ..... ....... i----•-...._._..... ...-- ------- PrivateCharacter of-soil-to a depth of 3 feet; Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ,,,Hardpan ❑ Adobe [] Fill Material.- --- ....If yes, type--------------------I...... ..... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) ! NEW INSTAL.ATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet) PACKAGE TREATMENT [ SEPTIC TANK [ l Size`- �f --.------- -- --------------Liquid Depth._6V_.-----...._I Capocity/ .N0-=.--- Type 449:..Material--------------------------No, Compartments.--- --------------------- ��` Foundation/¢ T`-. Pro Line--. P..._ Distance to nearest: Well___-!Q.. ........:.... - P• � LEACHING LINE I ] No. of Lines .. .-- -_--= gth of each lineF: C?_______________. _.Total Length , - -------- -- Len C� 9 D' Box----....._Type Filter Material/, --:Y �,Depth Filter Matenol---.A��---------------------- ,. . . . - .�,� VV- fir— ._ t"^�` , �� T � r , Distance to nearest: all__ _f`7° "_._ Foundafiori--.-.ct� _____________Property Line '�i/�~µ-- _ = SEEPAGE PIT [ ] Depth........ _ _ -Diameter------------........Number-------------------------------- Rock Filled Yes ❑ No r [- Water Table Depth- ---•-------------- ........... Rock Size--- -- ......-- -- - -------- - •---------- Distance to nearest: Well---------.-'-------` --- -------- Foundation----------------- -- -- ---Prop. Line..- REPAIR/ADDITION (Prev. Sanitation Permit#--------_------- -- ------ .......Date---------__._-.--_------__----- ---.----------1 Septic Tank (Specify Requirements) y ----- r Disposal Field (Specify Requirements►................... ------------------- ............. e y --- -------------------------------- -------- _ -----------------------______ ______`.._--...._......---. . {. f (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 "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 orkman's Compensation -laws of California." Signed._- - `r Owner By-•----•- ----- .-Title--- ---- ------------ ------ -.---- --- (If other than owner) FORD ARTMENT USE ONLY APPLICATION ACCEPTED BY____,:-.- - - ... ..... -----� �---- --=-----=---..,.::_-:�•��.:-_:-:.DATE DIVISION OF LAND NUMBER -------- ---- -- ---....... DATE --- ;:........--.,,. ADDITIONAL COMMENTS.... ......... . ------ ------ ----... ----------- ------- - ..-- -....._ i ................:- ------ -------------- - ------j- _ -. ._.----•---___ -•---------- ---------..-_._..... _... -- -- Final lnsgenon b ---------- ----------- ate.-- .. - EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT ras 21677 REV, 7/76 3M