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} FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT I Permit No,"-/-... .--:-_ .i (Complete in Triplicate] i . -- ----- ------------------- Date Issued---•`�--�i..-- 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/LOC ON.. --------- -------- _ fNSUS TRACT-- ----_-------- ------ ---- // ....Xg,5'6.-. Owner's Name oN44 -....?...1!AIL -J(.!�f.:. ..... r Phone.. _� .. ---- Address ' QS..-- Contractor's Name....eA#[ � � C��s .. ...-- . ....- License #. �$ ',�.. _Phone.. - ." .3 i f Installation will serve: Resid'encep!� Apartment House ❑ Commercial ❑ Trailer Court ❑ // Motel ❑ Other.. - - -------- ----------- Number ------- -Number of living units:.......l..-----Num ber of bedr ms.. . -Garbage Grinder_A/!__Lot Size._ -.-�i -.- = ... . Water Supply: Public System and name----... ..--- ------ . ? --------- - ......... ---------Private ❑ Character of soil to a+depth of 3 feet: I Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay; Loam ❑ ; :—�— •=-� NcTrdpan ❑ Adobe Fill Material.. ..-- -...If yes, type----------------------- (Plot pian, 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 pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK 11' Size ------------ -----------------------•----------- ------Liquid Depth------- ------.__.•---------- Ca Capacity Type Material.. - .--No. Compartments...------•--1......---_...- p Y------- --- ----- YP ----- N ...Pro Line----------- ---- -- Distance to neatest: Well.:..:................................------Foundation----------.- ... -.-- P• LEACHING LINE [ ] No. of Lines.'-- -------------- -'Length �of each line.---.---.----.-.--.-- -- -..Total Length -......_....-------- j. re Well_-_-.__ _Foundgt on..------------------ -----.Property Line...--------- .........- ..------ D' Box-._ . . Type Filter Material...---- Depth Filter Material--------------- - -- -- - --------- -- ----------- -- Distance to nearest. W ... .. __ SEEPAGE PIT [ ) Depth.......... ---.-. _.......Diameter..- - -----.Number-r.---------------------------- Rock Filled Yes C] No ❑ i y Water Table Depth..------------------ --------• .Rock = Foundation..- -_"'....._f.. .Pro Line-- .---.. Distance to nearest: Well. ------`----- -------- I r .-...... p. Date REPAIR/ADDITION {Prey. Sanitation Permit#.-------- - ----- i ' i rl � ......... Septic Tank (Specify Requirementsl_...- -------AS = �. f �1 /e---- off.. ...� Disposal Field [Specify Requirements).c,$Gi/.JL ----- -------- -----------------•---'---. --------------- ------- --------------------------- -------------- ------ --------- : .... AN j (Draw 6xistibg and required addition an reverse side) ; - '.A have I hereby certify that I prepared this application and that the work will be done in accordance with'-,San, Joaquin County Ordinances, State Laws, and Rules and Regulations—ofthe San Joaquin Local Health District. Home owner or licensed agents signature certifies the following: "I certify that in the performance of i he work for which this permit is issued, I shall'hot employ any person in such manner as to become subject. a Workman's Com sation. laws of California:".-—2: °' N i California."',- 4- Signed------ ...... : {caner . _ . -...----•------------------ ------- -- ---- .......... [If other an own '* FOR DEPART li ONLY T T� APPLICATION ACCEPTED BY........ ... .DATE _... �.d DIVISION OF LAND NUMBER.-- ------- DATE..... . . ADDITIONAL COM ENTS -------------------- ..... .. ------- ----------- ----------------- --•-------... ---- Date. -.�_ ------ Final Inspection by:.-.- ... ..:. .. - � F&S 21677 REV. 7/76 3M FH 13 24 AN J AQUIN LOCAL HEALTH DISTRICT