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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 16-_/� }� ------------ - --119_/. (Complete in Triplicate) Permit No.. �y �7(� L,/I`�ZG 7 41 Date Issued.-1- -/U •--------------- --------------------------------- __ 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: JOB ADDRESS/LOCATION._42-4 R_ `p n G�' ------------------------------ - -- ----------------CENSUS TRACT--------- -- --------- --------- Owner's Name /'7 a r-- ------------ ---- --------------- - -------------------------------------Phone.------------------------------- Address.----- ------------------------------Address.----- ,111_.S''--------/T ------------ -- ------------Ci ------ ty-TIf ---------------------zip--------- - - .- Contractor's Name_ _t�i.�G�rQ�+i_ ,l`E',pF_5�!Far- 'I�, _--_-Lc R.� C License #---3_v0;7,_,P.9.2_-..PhoneL.t-0'7_ 'Z!. 1_4+A7 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other---- ---------- ---------------- Number of living units:------.- --_Number of bedrooms----,7-----Garbage Grinder------------Lot Size1_f#cCr,*XjS_7YA3*,!1, 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 ❑ Adobe k Fill Material -..--_____If yes, type-------------------------------- (Plot pian, showing size of lot, location of system in relation to wells, brags, ete:- e placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted�if public sewer is available within 200 feet,] PACKAGE TREATMENTGQ I ] SEPTIC TAONa � S zi e---L�•_=-- ._._ �CA�'-------------------Liquid Depth---�'�e.---- ---- Capacity- 1 --Type-----------------�M-ateri-at- - -y--------No. Compartments---------- 'Z------------- ---� Distance to nearest: Well__.____f-_Q-Q---_______________________Foundation.___-r_d_t_-..--.---.Prop. Line.___ � _,------ __ LEACHING LINE No. of Lines--------- of each lina.______�Q- .. .1 Total Length.___,�_Z0_--- ________________ w � > 'D' Box-----)(----Type Filter Material-----1' �G _Depth Filter Material----- - --------.------------------------------------------- Distanceto nearest: Well_____- _ 'Q--- --------Foundation-------;<-�_f_-______-_---Property Line....S�Q__--____________________ SEEPAGE PIT [ ] Depth__--------------Diameter-__-.----__-----_.Number__.____--.-.----_r_ ------------- Rock Filled Yes ❑ No Water Table Depth------------------ ------------------------------.Rock Size------------------------------------------------ - Distance to nearest: Well----- ------------------------------Foundation-------- -----------------Prop. Line--------------------------- REPAIR/ADDITION (Prev. Sanitation Permit#--------------------------- ---------------------Date------_..--- Septic Tank (Specify Requirements)._- A/_------------------------------------------- --------------------- Disposal Field (Specify Requirements)-- �--Q� X .s - 'r L Gi_._L/-.�► 5 ------------------------------------ --------------------------------------------------------------------------------------- "4 (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 spanner as to beco su je t to Workma mpensation ,laws of California." SignedOwner , tom^= rL By------- --- i - -------------------------- - ------------------------ ---------Title_------------------ Of other than owner) FOR DEPARTMENT USE ONLY 0* APPLICATION ACCEPTED BY- -- -- ----- --- - ---------------------------.- ----DATE DIVISION OF LANA NUMBER. ----------------- -----.DATE----------------------------- ------------ ADDITIONAL COMMENTS------------------ ---------------- -------------------------------------- ------------------------------- -------------------s------•----------- ------------------------------ -------- ---------------- ---------------------------------------- - -------------------------------------------------------------------------- ------ ----- -- ------- ----- -- -- ------------- �`ial Inspection b ------Date.------��---�----_-- _�. 3 24 SitAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV, 7/76 3M __ -