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.i FOR OFFICE-!`SE; FOR OFFICE USE: -' APPLICATION FOR SANITATION PERMIT _ # ---------------- ------------ ------------------------------------------ --- (Complete in Triplicate) Permit No._!_u_- -------------------------------------------------------- ,f Date Issued.-?..:21.._215 __________________________________________________________ This Permit Expires 1 Year From Date Issued Application is hereby made to thle 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/LO TION.-- �f � .-:!_.,` -:�,__:-,--:-.-e -_.._ � } -- -CENSUS TRACT-------------------------------. Owner's Name---- ------------------------ --- -z.�r2a----- ; -------------- ` --------------------------- � Phone ,r .,. Address--------------- - �. ' -e- - - �' „_. City. - ZAP::: ---- f' r e� Contractor's Name = - ---. - -----`.License# ----3,;2 'ZR Phone---------------------------------- ---------------- Installation will.serve: Residence ❑L Apartment_House.❑—...:Commercial [J "Trailer Court ❑ ' Motel El - Other --- -- _--_-- Number of living units:............ .Number of.:bedroomst Garbage Grinder r-Lot Size-- '. ---- _._..,/ Water Supply: Public system and name '' - ------------- _+ -----------------------------------------Private IJ . ~s `� e dy_Loam ❑ Clay Loam ❑ Character of soil to a de Had an et: : Adobe, -4(Fill Mat real..:..- Peat es,typ n` r (Plot plan, showing size of lot, location of system in rel-afion to wells, buildings,-et� must be.placed on reverse side.} 44 NEW I ETRE TIO NT e tic tank or see age spit permitted 1f public-sewerisavailable within 200 feet,) /� PACKAG INSTALLATION:- [(Nos septic [/'] :Sze _ ' �+ _ Liquid Depth.:__`_..---------- -------- ` X 'S # Capacity_ 1<o� ------ .Type-- 'cue•-- -'- ` r C" --------No. Compartments` - ' distance to nearest: Well.:__---- 5 Material . Foundation- �.d...�_______Prop. Line_._ ___.______- LEACHING LINE_ [ 'No. of Cines.-------:�_- Z g - ' g ,� Len th of each line_.__.:.... ..________________Total Length. _ ..._- # D' Box-'�-__/___.__Type Filter Material------ Filter Material------- Distanc�to nearest: Well_,____5�_'__° _Foundation... ...LD_._._________Property Line_..-..5--------------- ., __ • 1 I _ , SEEPAGE PIT [ Depth._ _'�2�____Diameter_;._.- -------Number _-----------______ _Rock Filled =Yes No f Water Table Depth.. -- ------------ -----------------------Q� ------- ---- - Rock Size, I Distance to -W -- -___---_ -Prop. Line____ _..!_......_ REPAIR/ADDITION (Prev.-Sanitation Permit#_a_.-._*-_..._ __ "' --_ ------------------=------•------.gate--------------------. - ---- � Septic Tank (Specify Requirements). = = 4y -----=----------- =-----=------ ---------------------------------' ---------- Disposal -----:--Disposal r , Field (Specify Requirements)— •------------=--------------------------------------------------------------------------------- t ------------------ -=--------------------=----- ---------------.:--------- ------------------- --.- ----- -- _ - .. .. ------------ -----------=-------- -----------------------------'- ----------- ----------- -- - ------------------ ---- ------ [prow existing and required addition on reverse side) f I hereby certify that 1 have prepared-this=application and that the work will be done in accordance with San Joaquin Ordinances, State Laws, and Rules and Regulations of the' Sari Joaquin Local Health District. Home owner or licensed signature certifies the following'° u.. "I certify that in the performance of the work for which this permit is issued, I shall not employ-any person in such mann t.l to become subject to Workman-'s Compensation laws of California." , Signed---------------------------------------- - ------------ ............. _ Owner �Y r r BY ------------------------------ ------------- --C --- -Title � ,i -------------- I [If other'than owner) FOR DEPARTMENT USE ONLY f �} APPLICATION ACCEPTED By - ------------------------------------------- ---DATEs2t1 - DIVISION OF LAND NUMBER.___' -. .QATI=.... ------ - --- ---------- -= ADDITIONAL COMMENTS----- ..""_----.__-__. ---- --- ------------- ------- - ---- ------------------------------------------------- --------- -----. -------------I----- ------------------------------------- --- ------------------------------------------ -------------------------------------------- ..............................................71; ...... .. . _ _ _ _ .. -' k Final Inspection by:------- y - - Date --- � 7, -------- ------------ _ _ - - , EH 13 24 SA JOA IN LOCAL HEALTH DISTRICT F85 21677 REV. 7176 3M