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FOR Ot,�FFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit -------- ------- -- -- - (Complete in Triplicate) Date Issued__ .--.�'-77_ --- ----- -------- -------- ----- _ _ ---------- This Permit Exp irel.s, Year,From Date.issued V , r. : 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 Ord' once No. 549 and existing Rules and Regulations: Ilr.._._ffA -®= -'3 2' - ------ ---CENSUS TRACT------ --------------- --------- JOB ADDRESS/LOCATION___ - - `. Owner's Name jT/� 4/ :. r _City---------- W G iP Address--- ------ ire ---- �Q- Z i :rA x: Contractor's Name- i �4.12'rC .l_. .I-�j 'ti, m ,�, /' = License #a. Phone r Installation will serve:' ResidenceX Apartment House.❑` 4-Commercial ❑ Trailer Court ❑ .' Motel E] s Other-- -------=------------==- ------- -. Z �- Number of livingnits_____ g ZO Number of bedrooms:.._____.---Garha a Grinder._w --' Lot•Size_.__,_b- -----------------------•-- - -------'---- -------- + ! f k. Water Supply.:,Public System and name_ - - .- -- -= -- ------- -� � JT2 - _ --*----::---_--_--Private Character of soil to a depth of 3 feet: Sand ❑ Silt ' Clay 0 Peat.©� Sandy LoanClay Loam ' - Hardpan ❑ Adobe FF]'i,Ma ria)_ ---If es; e-------------- ------------- t r f (Plot plan, 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 pipermitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] 3 Size' '`----""------------------------- ---------I-----Liquid Depth..--------- `------------ I Capacity:----- - -----TYPe-----------------------Material------- -=-=---- No. Compartments - Distonce.to nearest- Well----) ------------- ------Foundation--:-----------= --- ---Prop. Line--------- I---------------- LEACHING LINE [A No. of Lines --------- ----.Length of each line._,-:------ -------- -------Total Length-------------------:--------------------- D' Box------------Type Filter M'i derial--------------------Depth Filter Mater.ial---------------------------------------------------= j -------------- Distance to nearest: Well__ .-�_-_--._______'.....Foundation-___._..._------- ----------Property Line- .,. Mw . - - Rock Fi11ed`'Yes Na t SEEPAGE PITS,.[ :-] Depth----= ------- --Diameter-------\_----:=_Number----------.------=----- ----- ❑ Water Table-Depth-----------------=�"---------- -- '.� Rock Size----------- I---------------- Distance to nearest: Well-------- ---------------------• ------------Foundation--------- ---- ----------.Prop. Line--------------------- REPAIR/ADDITION (Prev. Sanitation Permit ------------------------ ---------------------Pate-_--,:e------------- ------------------- ` ------------------------`-------------------- _ ___8 --------------- ' Sepfiic Tank [Specify Requirements} --- --.._�-�.�_'T1_.11` --------=----- ----^-�-� __�.---- _ -- ------- -.. Disposal Field (Specify Requ'rements)_ '' - } � : .. E•� - -- 14 1 ---- ---- ---------------------- - = �3- - - _ --- -------- ------ --- .�' '. ' (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 t Wo man's Compen laws ci California. , .� -�. � ' ^ ' ----- Signed_ BY ---------- ..,-Title----------------------------- = = : .. I (if other than owner) l FOR DEPARTMENT USE ONLY ' - DATE._ - r ---- APPLICATION i ACCEPTED BY J �l -- -U ---------- --- DIVISION OF LAND NUMBER----- ------------ -DATE. '_.. ADDITIONAL COMMENTS------- ------------------ ------------------------ ------------------------------------ -- ----------------------------- --------------------- ------------------ --------------- - -- VJAQUIN ------------ -------- ---- ------------------------- - ------------ ---------------------------------- -------- ----------- -------- - D r Final Inspection bate. �'�------------------- - ------ EH 13 24 SLOCA HEALTH DISTRICT res z,67�7/76 3M