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FOR OFFICE USE: i� FOR OFFICk USE: V0 } pfoAPPLICATION FOR SANITATION PERMIT q $, ---- : 'f.................... . .. ....••. • Permit No.7S"!_•3._... (Complete in Triplicate) p ..............,..------ -------- - -------- .I Date Issued-/D'� .............................__ ___ -----.......i`...... 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 unty Ordinance No. 549 and existing Rules and Regulations: ,I t ...----..CENSUS TRACT..-------•- --- JOB ADDRESS/LOCATION -`�'��LrJ-_�(.,....- ---. ..... -••- �---�[.-��- ----- -- --- --�-�-- ...---;------ 2 � --- Owner's.Name............... i _ -.._�. ...... .......... ------. .........Phone_.rPr.. S Y73 •. Zi x- .. � ... ... Address.._. -=--...:�... --- --- -- - ------- -- � - - -- -- - ------�- City---•- -----., . -- ------........ - L� 11 II�- Contractot's Name...::...... ... .License # sr` ._3T.>.....Phone. .- .�... ....... Installation will serve: . I Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ - Motel ❑ Other------------ ------ -- •-- •----------- Number -- -----Number of living units;......,__:.'.-Number of bedrooms- ..Garbage Grinder--......-.:.Lot Size........ .. ... . .... .........:. Water Supply: Public System and name- ----------------- ...... ._....--. --- -...... ----------------------Private Character of soil to ajepth of 3 feet: Sand ❑ Silt [❑ Cloy ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ 'Hardpan ❑ Adobe Fill Material._ .... ....if yes, type..................... . (Plot plan, showing size of lot,,�Iocation of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION:' (No s6ptic.tank or seepage pit permitted if public ewer is �voilable within 200 feet,) �l PACKAGE TREATMENT,-1 } SEPTIC-TANK Size....... ...... -- ----------- --. - ------Liquid Depth._X ........ I 4 CapacitY.�{��---�--TYpe--- MateriaL. ......No. Compartments. .. Dislan11, to nearest: Weil'..! Foundation:.---.�_� Prop. Line_.- --------------------- t / LEACHING LINE. F No. of Lines ._...Z......... ......Length f eoch line ..---. ---- Total Length gth ..LT ----.._..._.......---:--- ------------- - 'D' Box..{✓-T e Filter Materia€:.: .. _Depth Filfer Material-- ---� -_- Type t p r �. Di stance,to nearest: Wel I.....f.0_........---Foundation-----f-4----- ---------Property Line.. 5-_``--......---........... SEEPAGE PIT De th't.,-7 5 Diameter_.-or6_-- ----- . Number___........`�-------.--- Rock Filled Yes No ❑ _p,- = ----- j, Water Table Depth.---------__----------- � ---------Roc Size_ = 4 Distance to nearest: Well..----- l . ........... . ........Foundation... -l:Z�.-� -....._.Prop. Line_-...>__t!= .- -- REPAIR/ADDITION (Prev. Sanitbtion Permit#--------------------------- ------- -- ---------.Date..............- .........................I------ Septic ---Septic Tank (Specify Require`Ats). 7 . . . ............ ---------•--•---------- ----------- ------- -- ---- R . ------------ - _- .Disposal Field (Specify Requirements)_- ------------------------------ ` .._ --- . _�----- ......... Y --- ------------- ------ �_.-..--::-_--...-: - -- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County' Ordinances, State Laws, and Rules and Regulations .of the San Joaquin Local Health District, Home owner or licensed agents ,signature certifies the fallowing: "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 to become;subject, to Workrriian's Compensation laws of California.", Signed-------- . . 1�� ---_-- - 4 - ---�-� wne•r: 11 Tit le..=....... � - { oth` owner] a • DEPARTMENT LY .. . -DATE -- -------- APPLICATION ACCEPTED B DIVISION OF LAND NUMBER.. ----- - --- DATE...... ADDITIONAL COMMENTS...... ...... ..... .. ............ ... . . . .. fir; ....BK_ ._.:.3.G �`: -zs .. '-- -- ----------------- ............................ .---- . .. . . �: ----- . ..---- . . if final Inspection b Dat . . y/ _ ----.......----•��--*-•------ � --- e' - -gyp � - ¢ I` � - EV. 7/76 3M EH 13 24 SAN JOAQUIN LOCAL,HEALTH DISTRACT F&5 21677 R II � "