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-,FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------------------------------------- -- (Complete in Triplicate) Permit No.74T-1 �_$�__ --------------------------------------------------------- Date Issued--f �$ _________________________________________________________ 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 County Ordinance No. 549 and existing Rules and Regulations: , JOB ADDRESS/LOCATION---- �. - � � i✓l (:5-7------------------:---.CENSUS TRCT -------------- ------------- Owner's Name- i '�i$ �'-/�1 i ._.. =---------------------------------- _.Phone--------� Address ___ --'6_1"--3_:./"„ i 7YI U - City, ._Id'1r�. '20'P Zip rl� n Contractor's Name--- ----- - ---- --------- -.--License # /, ---Phone- Installation will serve: Residence�! Apartment House.❑ . Commercial ❑ Trailer Court' ❑ I 1�'. s - Motel,❑., .Othe -------r_ Number of living units:__:__/...........Number,'of bedrooms_-:'�.--"Garbage Grindar_--__'___Lot,-Size._------------_________.__-.-.__..-__-------------------- Water Supply: Public System and name _.__. ts - _,. '' - ` - :_-..,.: ------------Private ❑ Character of soil to a depth of Veet. Sand :Silt -%la Peat.❑ Sand Loom CIa y Loam I? ❑ ❑ Y ❑ ' Y ❑ Y A f Hardpan ❑ Adobe❑ Fill Material-----------If yes, type-.----_J`_:_, __t-- _. _ _ [Piot plan, showing size of.lot:location of,system in relation to wells, buildings, etc. must beplaced on reverse side.] NEW INSTALLATION: {No septic"tank•or`seepage pit permitted if public sewer'is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK"'[•'•] ` Size_ "fl i. "~ ` } � 1 [ ] ��'b- -��-------------------Liquid Depth LJ�•�-------------- y/., p i --TYpe�' �� 'Material------..... = No. Comport Ca acct - `_:_- i� �►------ . ..Distance to nearest:.Well:_�� ----------- --------------Foundation Prop. Line__1_& LEACHING LINE [ ] No. of Lines.--a-_.-__:_. Length of each,.line/11l ------------------.Total Length _ a,Q__ ___________ i -.. .Type Filter Nlaterial____s ._ ....... D' Sox= ._.-......T a iter Material- Distance to nearest. Well-/". Foundation.-_ ------ _;:_____-Property LFnE ----------------------- SEEPAGE PIT [ ] Depth------ --.-Diameters Number ----- ---------- -------- Rock Filled Yes ❑ No ❑� Water Table.Depth __R °� __-__-Rock "" --- - ---- n .: ---- -- -- Rock Size '-"'� - - �- ' Distance.to nearest:"Well_.:._;_ ___W-------------------- - """ ----- Foundation ----------------------- --Prop, Line -------------------------- REPAIR/ADDITION - ---- -----------=---REPAIR/ADDITION [Prey;Sanitation Permit#_ ! :--.--I__----._-_"____________ -----------Date-----------------------.Permit ------ ------------------------------- Septic Tank (Specify Requirements)---------- --- -- - ------- ------------------ -- ---- ------------------------------ --------- i Disposal Field (Specify Requirements)..----------------- ------------------------ --------------------------------------------------------------------- ---------------- --------=------ ----' - - ----------------------------------- -------------------------------- ----------------- ii "" """� "�' } ''w '-�.?�--»►-[Draw existing and required addition on reverse side] i I hereby certify that I have prepared this application and that the work will be 'done in accordance with San Joaquin County Ordinairtces, State Laws, and Rules and Regulations of the San Joaquin Local-Health District. Home owner or licensed agents signature certifies the following: .r F. y;.t-cern that in the ^t, £� t fy performance of the work For which this permit is issued, I shall not employ any person iri such manner as ' to become subject. orkm, s -Corn pensation-Jaws,of California." Si ned__ �' _ }..._Owner By ; - ---1. ------ ---------- ---------------------- -------- ---- ----- - -.:---- --------------------------- h (If-other than owner)` F DEPART ENT USE ONLY c APPLICATION ACCEPTED BY = - - = DATE DIVISION OF LAND NUMBER------ - ----------- ------`------- ------------------- ---t-- - -------------------------.DATE-•------------------- ` ------ ---- -- ADDETIONAL COMMENTS _ __ ---------------"------ - - .w'•R - SM -------------- --------------------------------------------- __ `. ._ ___...___... ____ --__ _.__ -" -------------_ -------------------- r. Final Inspection by -. -�----------- Date.----_��.. ~.. �Z EH 13 24 SAN JOAQUIN LOCAL.HEALTH DISTRICT -r'Fas 21677 R 76 3M L