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FOR OFFICE USE FOR OFFICE USE; APPLICATION FOR SANITATION PERMIT q Permit No.7./•'f = (Complete in Triplicate)_ ,y r ` V. L Date Issued.v."� --~=. This Permit Expires I.Year From Date Issued -- Application is hereby made to.the San Joaquin Local Health c strict I as permit existing Ruites and Regulations:ruct and install the work herein described. This application is made in compliance with County O of L e5 Te / fjY /�a0 ....... .........,.y:....... ^ ..--•--......_._.. -,CENSUS JOB ADDRESS/LOCATION. Phoe.q`-. ? --------. - t Owner's Name....., �1 ? #_. .. .. �........ Zip...:�Y :i.� !.............-- City... .' . ._.�..:3... ._a..-.I-;-5-.- ---..._Address__... � 6. Phone Contractor's Name.... TeR'y................:........ ..... ..... . ..... License . ; Installation will serve: Residence { Apartment House [] Commercial F-1TrailerCourt C3 Motel ❑ Other... ..... ........ ...... ........ b Number of living units:..:._..:...--.Number of bedrooms.. ..-._ Garbage Grinder.--..-----.-lot Size— : W private �/ Water Supply: Public System and.name..._.--_.------ - k Sand loam [] Clay loam ® Character of soil to a depth of 3 feet: 'Sand ❑ Slit❑ Clay ❑ Peat ❑ Y e......... .............. ....... l Hardpan ❑ �tAdobe ❑ Fill Material . .... . ..If yes,type.-- , , - ced se (Plot plan, showing size of lot, locatio hof system in relation rm ttedsifbpublicsewer is aavabableawi hon 200efeet lde�j Y NEW INSTALLATION: (No septic tank or seepage p p .f r _...Liquid Depths-.:.-`:.........."...._."_. �• � Size.........- •.."......_... _ . PACKAGE TREATMENT [ } SEPTIC 4ANK I } Go..... •..,...,No. Compartments.......- .................... Capacity-. l .D O TYpe•_Ore 6067 Material--- _.G• to......... ...Prop. Line..--4F"`........ r �.:._._ _'.... . ........Foundation........-. . Distance to nearest: Well_:..........-; - LEACHING LINE t } No. of Lines ............................Length of each line.......-•-- Total Length ...................:.. ...... . ....... j - D' Box_ ../--.,.-.Type Filter Material.Racf:•-••-".,Dept iFilter Material_...... �• :•-•- t d _...... _ . . Property Lina..... ---•................... . Distance to nearest: Well.......S.-•• . ...Foundation.-- Rock Filled Yes ❑ No❑ I 6 , SEEPAGE PIT [ } Depth ......._.. ....Diameter....................Number.......................... ..... t _ Rock Size..;,.. ........................................ . ..... ...... i Water Table•Depth.......................`.. .Pro Line.............. _..---•Foundation__............ ..... .. p. Distance to nearest: Well...................... . , `t .... . ................Date.......... ...... ......_ .. REPAIR/ADDITION (Prev. Sanitation Pi rmlt#.........-••-•-:•=•••-•• ... . .......,........... ... ( Septic Tank (Specify Requirementsl.....�.............:... • ------ .. •. •.--- ..... 1 _.-............. Disposal Field {Specify Requirementsf .................... ............................. .- ...................••. ............ ...-......_ .......... ...................... -" ....._.. ------ .......... .._,... .._............................---- , .................... (Draw existing and reduired.•addition.on reverse side ccordance with San one In a 1 hereby certify that I have prepared this application and that than Jaa uinitocaldHealth Districts. Home ownerr or,oaquin lic nsed °ge County Ordinances, State Laws, and Rules and Regulations of the 5 4 signature certifies the following: to any person in such manner as l "1 certify that in the performance of the work for which this permit is issued, 1 shall not errtp Y to become subject to Warkmon's Compensation laws of California." ,r Saetl Owner Signed...... .'A-�rT.�» J,. ;........ ................................ � Title� _.. ...... ..... ... ........................ ....:... erha owner) ` fOR DEPARTME T USE ONLY e �.. ................ DATE r . ........................ i APPLICATION ACCEPTED BY_. ..-- DATE. ... ...................•. 1 ..._..1........ .............................. �IVISiON OF LAND NUMBER.__..._. :..._ _...................... ........... ... 1 ............................. ADDITIONAL COMMENTS............. .......... -• •--- -...... ...... ,...... .... ` "_-_."._-....-.'. ..._._..'.................."r............. Y_ ........... ...._ .._........ Dat :. t . FaS 21677 REV.7/76 3h Final Inspection b Ex 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT rA, ,�