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FOR OFF1C -USE; FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT j ii Permit No-.� �-�?- ....-----• /'�G ------ (Complete in Triplicate) Date Issued-p ?/7F This Permit Expires 1 Year From Date Issued ll the Application is hereby made to the San Joaquin Local Health DisNor549 and existing Rulfor a permit to truct and Regulations: work herein described. This'application is made in compliance with County Ordinance y }-.... ------.CENSUS TRACT------- -- . ..... JOS ADDRESS/LOCATI :.......-/ 4�.' hone.... Owner's. Name , Zip .- ,,�. S ....... R Address--.. .5 City,�� -- ------ ---•-- �--.. hone_... = Contractor's Name..- _.License #- .--- -...... -- - - -- - - Installation will serve: Residence Apartment House❑ ❑ C mIn rci El Trailer Court ❑ Motel ❑ Other Number of living units;---- ------------of bedrooms---A .Garbage Grinder------------Lot Size-------- .- 'Private q' ------------- - Water Supply: Public System and name------- ---------- ------------ - -- - --- -.... .- Character of soil to a depth of 3 feet: Sand Silt ❑ Clay ❑ Peat Sandy Loam ❑ Clay Loam ❑ < < Adobe Fill Material.. ---. -.- If yes, type------------- Hardpan ❑ ----_—�--�— (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) P r n NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 01- -------Liquid Depth..-- �...-._.-_{� � Size _.. �.a�-��-----•------- --•------------- '{ f PACKAGE TREATMENT K SEPTIC TANK f T e..- i^N.-ec� Material.-Car^-cP c �'_..No� Compartments--------:2----- --------- --- ---- Capac�ty.f�d.�$- Yp /� ' 1/ Foundation.-� �.. F Prop. Line - - fi..... Distance to nearest: Well.-------. s� �/UU X�6 - --�--------------Length of each line....-----`�-.----- - -Total Length .. -- -- --..-- LEACHING LINE Al No. of Lines -.-- 1 'r 'D' Box...../_....Type Filter Material,jr%ic.Cotk.Depth Filter Material-..----...-� 11`` � If r Distance to nearest: Well----- 5� --.. -.-.Foundation--------r-�--� Property Line----•--------- f Rock Filled Yes ❑ No SEEPAGE PIT [ ] Depth........_......Diameter........... ---- Number---------------- -- Water Table Depth------- - ----------- -- ------ -------- .Rocckk .---- ...... -._ p. Foundation_-.Size.-... ....... Prop. Line.. --- ---�.. Distance to nearest: Well------------- - .............. _ s -.-----,-----..W._._.. . ---- ------ --- REPAIR/ADDITION (Prev. Sanitation Permit .............. .... -- = ---- --.-.Date., --- ----- �. - . G I Septic Tank (Specify Requirements)-___.-.-- -------------- Disposal Field (Specify Requirementsl_ ----------- --- ------------------- .. ...... ................ --•--• _s ------------- •------- F (Draw existing and required addition on reverse side) ance I hereby certify that I have prepared this application and that the work will be l Health District. Hoe owner or'licensed agents ' Ordinances, State Laws, and Rules and Regulations of the San Joaquin L i signature certifies the following: "I certify that i the perFormance of the work for which this permit is issued, I shall not,emplay-any person in such manner as to become su a to Workm Comp satin laws of California.- or ..Owner F w -.._ , Signed_ ---- Title.._fe__r� -------------- ` (if other than owner) f OR EPART NT USE ONLY . DATE ._.-.-la_.I.7...�.�..... ...... .. APPLICATION ACCEPTED BY- ----.. . ..DAT - -- - - -- - . - DIVISION OF LAND NUMBER-------------- ...--_....-.---_---•- ADDITIONAL COMMENTS-- ---------- ------- ------- -----------•--- -------- - ------------- --� ------- ----------- ------------------- -- ---•----------- --------- ------- bate... -- Final Inspection b Fes D677 REV. 7/76 3 I EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT