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AOR OFFICE USE: FOR OFFICE USE: _ "--APPLICATION FOR SANITATION PERMIT � --------------------------------------...._ Permit No..7.74'lG3 (Complete in Triplicate) -- ---------_--------.-----------.-----------_--------- This Permit Expires 1 Year From Date Issued Date Issued_S-= - ._ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. his application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION------------- . K0571, 6�--V-�-1---��---�✓V'-- -CENSUS TRACT--------------------------- >wner's Name..-- ---------------------------- -------------------------Phone----��...w-.Jr--.. 1. .._. --- ddress - s' LK 1s ---------------------- -G- --+--------------- ----- -City---A-cf-D-1------ --- --------- -Zip------ - --------------------- ':ontraotor's Name- --------._- .--.----.---------------License # S i...Phon� . �= „nstallation will serve: Residence Qct ,Apartment House❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other-_. iv Dumber of living units:_.-1..:...._Number of bedrooms --Garbage Grinder.__.___Lot Size---140-6_.--. ---_----------- -tVater Supply: Public System and name--------------------------------------------------------------------------- ------------------------ ---- ------------- Private Sand Character of soil to a depth 3eet: ❑ Silt ❑ ipPt� Sandy Logrb ❑ Clay Loam E] Hardpan Adobe E] Fill Materalq_.--...- IfY 'bP :. I------- ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. musta placed on reverse side.) JEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) j ft.'ACKAGE TREATMENT [ ] SEPTIC TANK [ 1 Size ----------------------------------- ----------------------Liquid Depth--------__.___._�.._ Capacity----------------Type-------------------Material---------------------No. Compartments------------------------- ---Jo Distance to nearest: Well__---- ------------- --------------------_Foundation--------------------------Prop. Line----- ---------_-----.t....W LEACHING LINE [ j No. of Lines_.___-------------- ---___Length of each line_.-.._------__-.._----_.Total Length-----------.-------------._..._�0 'D' Box -----------Type Filter Material-_-_ ---_--------Depth Filter Material------------------------------------------__..-_-_-----�... i.. Distance to nearest: Well Foundation---------------------------_Property Line-------------------------- ---- . SEEPAGE PIT [ ] Depth__---- ------Diameter--------------------Number-.---- ------------------------- Rock Filled Yes-D No t i- t WaterTable Depth---------------------------------------------------.Rock Size------- ------------------------------------- Distance ---- ------Distance to nearest: Well _--------------------- __Foundation-- Prop. Line ---------------- - ^.EPAIR/AbD1110N.(eyev.5anitaTion Permi/t#h..-_ tmr --. ---.Date ) �iepticTarrfct(5'p.tifytequirements)----- 1 - -_ -_S.. -------------- - ---------------------------------------------- Disposal ____ _ Disposal Fielc} (Specify Requirements). 57_46AGl01 ---yid Ao+ c�--------------- -_. ^k T 1Drayv xfig and required addition on reverse side) {• hereby certify that 1 have prepared thisapplica4n and that the work wdl be done in accordance with San Joaquin CougfyZ ordinances, State Laws,- and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents[\ signature certifies the followil , . - '1 certify that in the performancei°of the work for which this permit is issued, I shall not employ any person in such manner as i -o become subject to War man's Compensation laws of California." Signed ----141�..artk- _ ------Owner -� 3y-- - --------------------------------- ------Title------------ ------- - -------- ----------------- -------------- (If other than owner) F R DEPARTMENT USE ONLY t,.APPLICATION ACCEPTEDBY ---_.'-. .._. .. ....- -------------------------DATE.6 -- -- -- -------------------- DIVISION OF LAND NUMBER-------------------- ',._ __ - ------ ,=DATE -- -- 4DDITIONAL COMMENTS--------- -- ------------------------ ---------- - ---------- -- ----------------- - -------- - -- -- ----------- --------------------------------- - -------- --------------- --- ---------------------------------- ----------- ------- --------- ----------------------------- ---------------- -------------------------------------------- ------------- -- ----------------------------------- - --- `, :incl Inspection by:------ --- -- - - - Date b ` 7� - -- ---- ------- �!H 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT pas seen acv.7/76 am