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i VL. FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 ` --------- --------- - Permit No----------------------- Date (v ------------ ------------- - (Complete in Triplicate) ----- - Date Issued_-M_//7e ------------ ----.:----------------- __.__._.-___-- -- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health D.iLstrictfor.a permit to-construct and install the,work herein described. This application is-made-in:.compliance vVith Count!0 d•narace:No"549 and ezisting'Rules and Regulations:'' r JOB' ADDRESS/LATION.. -__- - - -------------- --- - OCVZ ._ /_. .'---.CENSUS TRACK,, - _ r - /D on � , Owners - ----------- ----- � � - - -- - ---- ------ � -- -- - -- ---- C- - +�a �. ------------- ty ZAP 1 . Contractor's Name_ ------ -��3` -------------------------------------- -- License # /_ --------------- ------------------ Ion .✓ ' /Phone /_ __` =/ E Installation will,serve: s Residence Apartment House.❑ Commercial ❑ Trailer Court ❑ a f Motel ❑ Other------------- 01=-------------`- ----=- { of living nits_________________Number of bedrooms_._ g -------- t r ---Garbo e Grinder._.. Lot:Size --'- -- ---.---------- Water -- Number kWater Supply: Public System and`name :. _ --.---•--=------------------------- .---------=----- --- I -------- --- -- ------ �---Rr:iv�te [� i Character of soil to a depth of 3 feet: Sdn'd Silt❑ Clay❑ Peat ❑ Sandy Loam [] Clay Loam ❑ Hardpan Adobe-. Fill Material'1k �•=�1f'' es�>t i � �...f --------------- :mu ------ ------ t • –� t •m.... —w -w. .�` alar- rA•c. ...w. r.e ,.r< (Plot plan, showing sie of Iotlocatio `of' tem"in relation to wells, buildings,retc. must be placed'on reverse side.) 41. ,-P , _ R y NEW INSTALLATION:') (No se tic tank or seep ge pit permitted if public sewer is available within 200 feet,] >E � t PACKAGE TREATMENTS [ J SEPTIC TANK [. Size __ _C�"_._:= 'P" ___________________Liquid Depth_._____t_____..____._______ J Capacity - TYPe `--------------=--MaterialC �. -�C__No. Compartments ----------------- r Distance'to �eare'st;�Well._,j ] --------- LEACHING -- Q ------------------ Foundation -=/ Prop. Line _ - LEACHING LINE [ No. o Linesl--------_ ---------------Length of each line----��..:_i.__-•___ Total Lengtha -- %_-__--___ (p D' Box =5_Type Filter Material__-__- p ------ .: ..• r ----------D� th Filter Material ��. 5 Distacn a to nearest: Well-:Z :_-----Foundation--- ----___r_______ Property Line_ SEEPAGEI'PIT ['I' Depth Diameter--------- ..........Number # _____ __-------- Rock Filled Yes ❑ No ❑ .tet Watet P ll' ►e.: D E _._ - _ =• Rock Size ------------- [E I ,,r Distance to nearest: INeII.-------------------------------------- -Foundation------------------------ Prop. Line-------=----------=------- REPAIR/,ADDITION Prev, Sanitation Permit e-----__• Date � --- � = ----- --- -- ---- --- ---- a ----- -----=------=-------- - ---------------�--------------------- ------------- ----- .__ Septic Tank [Specify Requirements ------ ------ --- _-----------_- - , Disposal (Field (Specify Requlreme,n..ts)- . z r: _ - -_- - _ --- ---------------------- 1 14 {}------- ---------------------- ---- ---- -- ------------------ -- - (D�awex•isti' �,�` `� Y„ - -�-- ----- { --- ------------------------ - - - � ng pnd required;addition on .reverse side),. * s I hereby certify that I have prepared"this application and that the'work`TwilI be done. in accordance with San Joaquin County Ordinances, State Laws, and Rules'and�Regula.tions�sof the San Joaquin Local Heal#h-District,'Heme owner or licensed agents signature certifies the following: '+ e "I certify that in the performance of:the�Wo-rk'for w ihi s permit is issued, 1 shall not employ any person in such m nner as to become suh]e ti,to Wor n' s ti s-of� nia." [ Sign ------- . ............... --- -- --- -- _ -- ------ U3 . owner I I Y = '"`, _ - `� ------- --------------------------- ------ ----------------------- Z ---- t ,_ _ ... _:Tritle -- -- J . . :. (If other tho owner-) - Z ! - : - FOR DEPARTMENT#,USE ONLY r APPLICATION ACCEPTED V -- - , - -__ j `"" ----- ---------------------- DATE.__. __0�1�7 t _...-- DIVISION OF LAND NUMBER ._� -� ' ��'i�'�J"' r` ` .' ". 'o �'- ". ^"D4ATE� - - - -- ] I ADDITIONAL COMMENTS--------------._ . . . 4 --------------------------------- -- ---- -------------------- --------------------------- I -:----`--------------------=----------- - ------ ------- �' I ---- ' - - ---------------------------------------- ---------------------------------------- ------ ------^ �r----------- Final Inspection by. = r ---------------------------------------------- - ---------------------- Date ��`- ------- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 REV. 7/76 3M