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-FOR OFFICE USE: FOR OFFICE USE: t --APPLICATION FOR SANITATION PERMIT z Permit No.-- --- ----------- ----------- --- - --- -- (Complete in Triplicate) --- ---5 ------ --------------------------------------------------------- Date Issued._._-/i-___-_-_77 ------------------------------------------------- --- -- 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: fi --- 0------�---- --17 ,,�/� JOB ADDRESS/LOCATION._ ; CEN CT t - ------- --- -------------- - ._.CENSUS.TRACT Owner's Name _ - N r - 1 Address-- -------- � � { ' --- --- ---- ------ ---:-- - ------City 1.lvT ;--------- -----zip --------- Contractor's Name-- ---------- -- .� ,�._ U �- -. - ------ --------------------License -------Phone, /W I Installation will serve: y Residence �' Apartment House ❑ Commercial ❑ TrctilerlCourt ❑ _•F_.- A.. .;�. , Motel Other----------------------- -------------------- t,. :. ; i Number of•livin units:_ Number of bedrooms;.-,)_:__ Garbage Grinder-_ _Lot.Size g1 r -- ........ Water Supply: Public System and name ---- -- - ------ ------ _ :-- ----------------------Private f Character of soil to a depth of 3 feet: . Sand -Silt ❑ Clay ❑ Peat E] Sandy Loam'®' Clay Loam ❑ !ll...✓✓✓ 4 Hardpan ❑ ; Adobe❑ Fill Material-------------If yes, type--_:-__________________________ • i {Plot plan, showing size of lot, location of system in relati6n to wells, buildings, etc. must be placed on reverse side.J NEW INSTALLATION:— (No:Pseptic tank o ,seepage pit l permitted if public sewer is available within 200 feet,J ,J PACKAGE TREATMENT [ ] ;SEPTIC TANK a Liquid Depth. =------------- 6 Size--------- ---------------- � ' -----_-- ---- - 1 Capacity,fr -'a--�TYpe- - ----_ Material No. Compartments --- N. __... 'Distance to nearest: Weld,._'-, - ---------- —Foundati n` ------- -Prop. -------- --------- -- . LEACHING LINE F ' [,1. No. of L nes- Length of.each lin&.---------- ------Total, Length.-'------------- ------------------------- D' Box-1 :._Type Filter Material_ Y_____:_-_-_Depth Filter Material ------------------____ 4 ------------------- .D - -_ - t Distance to nearest: Well_E'er x°__` _Foundation______________ Property Line.-_____ O 1 .. ._. . . .i ._ y _ --t r SEEPAGE PIT [ ] Depth___i-__._-_____Diameter_ - ------------Number_______________________________ Rock Filled Yes ❑ No' t Water Table-Depth-------- ''T-K--------------------------------------Rock Size---------- -------------- ' Distance td nearest: Well._ c___________________ _ ____:Foundation__`_____-_______-__.___.Prop. Line______ ! i ... � _.Date ------ ----------- 1 REPAIR/ADDITION [Preva Sanitafion"Permit#______ ----------- --- - Septic Tank {Specify.Requirements] li --------------------------------------- ----------------------� Disposal Field (Specify Requirerentsj ---- ------- [ -------------------------------- ---------------------------------- ---------- i € , -- ----'-------- -------- '" "`"".'T Ear -- ---------------------------------------- --------- -------------------- ---` - i Y Y P - .a Q as r6d - ; (Draw existing and ,eq.uired�addition on reverse side) � �,� I hereb cerfif that I have prepared this application and.that the -work will be done in accordance with San0oaquin County Ordinances,' State Laws; and Rules and Regulations of the San Joaquin Local Health District,gHome owner or licensed agents signature c�ifies the follaitiring: "I Certify that in the perforrriance�,Vthe wo'rk-for which this permit is issued, 1 shall not employ any person in such manneras to become subject to WorkimaA sr Compensation laws of California." M Signed .r - - -----Owner. By-!= -------------:-------------:--------------------:------:--- ---- - ------ -----------__Title------------------------- i t I. of other. than owner] s. i ' '' R DEPARTM NT USE ONLY DIVISION OF LAND NUMBER:__..t__-._- .: `'BATE._-__--- -- - APPLICATION ACCEPTED BY :- = } --.-: ------------------------- ---- ` :- --------------- DATE-_-----------.- --_ -------_ - ------ ADbITIONAL COMMENTS___- �' : -- -------------- ---•--------- ---------- --- - ----_ -- -------- - ------------ -------------------- --- ---- ------------------------ ------------------------------- - ------ ------------------------------------------------------ ---- ---------------------------------------- r.t� . -------------_______---_----_------------------------------------_------------------------------,-__ - . i _ _ ______________ ____________________ _ __ .. Fina{ Inspection by:- �'_ ---------- ------..w---3 _ _ Date ---6 � [. - ... EH 13 24n SAN JOA UW LOCAL HEALTH DISTRICT-" , res 2167 7 Rev. ��6 3M 1