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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit - -------- ---------- --------------------------------- ----- (Complete in Triplicate) ------------- ------------------------ - -------- Date..Issued. 9�T �,-- .- .,� p_,.. F ..._ This Permit Ez gyres .1 YeapFro.rn Date.lssued%� ( � ; Application is hereby made to the San Joaquin Local Health District for a permit to construct and in IlQne work herein descr;bed. This application is made in compliance with County Ordinance No. 549 and existing Rules anc� egy i.00 - RN IS TReo 71_------- JOB ADDRESS/LOCATION--"_2�7 W- Ihone----------- --------- Owner's Name - �- --� '�`�'""" -- -------- - Address------------------ + _ 1 ------- - --------- -- ----------- ------- city e�-aC..L I_ zip License #--- '._Phone = p Contractor's Nome._ICy�:Q�-.--- Installation will serve: Residence Apartment House Q Commercial E] Trailer Court. [I' , .. . Motel ❑%Ot} er = = ' Number of living units:.___. ------Number.of bedrooms ._---Garbage Grinder---------- _Lot Size---- �. Water Supply: Public System and amen" ` . . --- --------------... -w _ ,Private + _ ' e ' Character of soil to a depth of 3 feet: _Sand ❑ _Silt❑ Clay ElPeat ❑ Sandy Loam El Clay Loam # _ Hardpan ❑ ` Adobe❑ Fill Material___--------_If yes, typeJ........ ------- (Plot ----(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 pit permitted if public sewer is available within 200 feet,) !� N,t. Size zr"-�-X`---- --------Liquid Depth '� ------------ PACKAGETREATMENT' [ } SEPTIC TANK;Alt , a Capacity_flzT --- .-iy_pe: Vi=i--- Materia_��r �------No. Compartments.__ _. .- -------------- f �o Foundation----- 1 '---Prop. Line--- ��+- --------- Distance to nearest: Well- :--- t BLEACHING LINE L : No. of Lines--- -----k---------- g line.--5 ---------Total Length:--_ Q�-------- _ Lent of each p j e Pt Filter Material---�-(3_ -- "-- ------ 1 D' Box-----1-----Type Filter Materia p f _ t7 - ¢ _�" ��------ ! Rocne Distance to nearest: Well_ ._ _____ ._ _Foundation Property Li N j Rock Filled Y Number_- i Yes o ❑ SEEPAGE PIT Depthc�.-��---Diame je'r+� �..,� ------------------------ Water Table Depth -r � -------- -------- t --- p f. -Foundation .Q .Prop. Line_-,�O Distance to nearest: Well._ ---- - 4 f tf ) - ----=- = � ---------f ---------.Date----- ---------- --------•----:--- - - REPAIR/ADDITION (Prev:Sanitation Permit#-_-________ ` n -------------- Septic ---- Se tic Tank (Specify Re uirements)------- --------- -------------- --•----.--- - - Disposal Field (Specify Requirements)----------- ------=----------•------+--------------€ j-------------------- = -------------r----- 4 }` } - ., --- ------------------------------------ -------------------------------------------- --------- -- --- ------------------------------ --- - f°._-- ------------- -- ----------------------------------- --'-`---- ----- ------------- ---------- (Draw existing and required addition on reverse side) _ I hereby certify that'I have prepared this application and fihat the,/-work will be done in accordance with San Jobcl County Ordinances, State Laws, and Rules-and Regulations oft a San Joaquin.6o it Health District. Home owner or licensed agents signature certifies the following: r "I certify that in t e performance of the work for which this permit is issued, I shall not employ any person in such manner as to becoli-. suk'ect o Workman's mpens i laws of California."Signed._ t.__ GQ .- v # k rv, -----Title_. - r' - -------------------- ------ .' " Of-other than ,owrier} . ( FOR DEPARTMENT USE ONLY' i DATE - :_q:Ca-%?----- --- ------ ---- APPLICATION ACCEPTED BY---------- - -- --- - - --------------- DATE.:---------- -------=----- ---- DIVISION OF LAND NUMBER ---------- j =r ' �. ADDITIONAL COMMENTS------------------------ --------"------- --- ------------------ --------------------------------- ---------- ------------------ ------------------------- -------------------- --------------------------------------------------------------------------------- --- - -- - ----- ---------------------------Date------• -' Final Inspection by:... ------ - 2- --- ---- - -- - �.._ -- -- ------•-- ---------- ---------- - - - - - f&S 21677 REV, 7/76 3M EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT