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FOR OFFICE USE: nPLICATICINFOR OFFICE USE: FOR SANITATION PERMIT 4 � Permit No.. � S F� -------------•-------------- ---------------------- ----- ----------------- _ Date lssued__�-,�._'�. (Complete in Triplicate) "---------------------------------- .--_---.---___----- ------------------------------- This Permit Expires 1 Year From Date Issued i A^31icotion is hereby made to the San Joaquin Local Health District for a pe'rAt.to construct and install the work herein described. Ti s application is made in compliance with County Or nce No. 549 and ' isting Rules and Regulations: � Q G ' C �E�. '=------------ -- --------CENSUS TRACT.--- . JOB ADDRESS/LOCAT �_________________ C, mer's Name__..__ -7 Q _.�� - — hone.--- 74 Address._ ------ _ City _ ZAP w, i G ntractor's Name #.=:? v T�/ Phone-- License 11 )_,_tallation will serve: Residence Apartment House.❑ Commercial ❑ Trailer Court ❑ ` Motel ❑ Other----------------------------------------- ---- l tuber of living units:_ Number of bedrooms_�-----Garbage Grinder------------Lot Size--------- _---��- L' ter Supply: P ----- ublicSystem and:name------------------ ---------------------------------•-------------------------- --------- ------- ---------------------------------Prlvatei. 0-wacter of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam❑ Clay Loam&-" j Hardpan ❑ Adobe ❑ Fill Material------------If yes, type.________._____________________ (Plot plan, showinsize f lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) l"cW INSTALLATI14-'J, No septic tank or seepage pit permitted if public sewer is available within 200 feet,) r r,�CKAGE TREATMEI� �} SEPTIC TANK [c �!`��iquid Depth . ---------------- CAd ---Material.------�_ a acitY I�DO------.Type--- C? ±-No. compartments_ - ' v r Dis once to nearest: Well--.-- _;00 -----------Foundation_ -1P----------------Prop, Line------------.--------------. LEACHING LINE ['j N ; f Lines-,,,,�---__ _...--------,-i.ength of each line.---7- ._ _ ______�_---.Tatar Length,----l�V----------------------- v ---------------- -- ; gfype filter-M04flwl/_Xo ----Depth Filter Mater alp fir` P �U r Distance to near stelf__ 1 --------------Foundation_: roperty Line ---t PIT [ ] Dep --,:,7 -Diameter:-�. ------Number-----� _T ------- Rock Filled Yes ' No'❑ Water Table a th-------- ---• --------- =.- Rock Sizes'_:_. p r ! �/` so 1 Distance to nearest: Well------/�------------------I --- _ of gdation------- Y ---.Prop. Lipe_- -- ---------- cPAIR/ADDITION (Prev. Sanitation Permit#---------------------- ---------- -----------------Date.__ `= -`_�- ) . ----- ;---ti % _..ptic Tank (Specify Requirements) ------------- --• ----------------• -------------------- -------------------------- --------------------=�"=`------------------------------------------------------------- Disposal Field (Specify Requirements)-------------------- - ---•---------------•---------------- - ------------------------------------------------------------------------------------------ -------------------------------------------------- ----------------- ------------- --------- (Draw existing and required addition on reverse sidel hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County drdinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents ignature certifies the following: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as Ta become subject to Workman's Compensation laws of California." Owner igned----------- ---- x ).Y--•----- ---- ------ ------ (I# other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --•-•- DATE. DIVISION OF LAND NUMBER . --- -- --- . DATE._. DDITIONAL COMMENTS-------------- s ----------------- ----------------------- -------------------------------- -----------------••--------------------•--------------------------------------------------------- -------------------- ------ cine) Inspection b ----------------------------- ----------_-------Date. /� - '-EH 13 24 SA JO9QUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7/76 3M