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FOR OFFICEIJSE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT : (Complete in Triplicate) Permit No.7._.__ra_ ------------------------- -------------------------- Date Issued. _P x'29 This-Per.mit-Expires_]...Y„ear-From-Date Issuif ` 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 O .. -_--- 4 A14 :.. ..-CENSUS--------- ------------ Owner's _ - ----- - T--- �. o �-: hne-v-. ------- Address - - �r _/2 - --- ---- --------------- city- F �.-- j ---yip-5ts Contractor's Name-=----- ------'-----------------'_-_-_ Installation will serve: f Residence ❑ Apartment House.[] Commercial � Trai Phone___.____-_____-___.___._._ _--- . . t y' Motel Zoe— !er Court ❑ , Co � ❑ Other --- -------- r Number of living units:__:_._.._`------Number of.bedroom.s------------Garbage Grinder___-,-.._":__Lot Size----....... ------------------------------------ Water .______.__,-._ "Water Supply: Public System and name------------- ---------------� ___.- �� 1 P p -----------==F----------- -------------Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ ` Peat ❑ Sandy Loam ❑ Clay Loam e ' Hard an ► ❑ 'Adobe❑ Material.. If yes, type - --- Pill ' CLQ r i� (Plot plan, showing size of lot, location of system in relation to'wells, buildings, etc. must be placed on reverse side.) OC1 NEW INSTALLATION: (No=septic tank or seepage �plf 'perrnifted if public sewer is available within 200 feet,} ; PACKAGE TREATMENT [ ] SEPTIC TANKSize Liquid Depth---------------------- -- l Diastan a to.near nearest: .Type ---------- Material No. Compartments- ----- -------------------- _',ti----_._. �`moi . .. Length of each Foundaticin---- -------------------Prop. Line------- -------------- ------------ --------- -- '- LEACHING LINE' [7] No. of Lines--------- - - 'h line------------------------------Total Length ------------_,------------ 'D' Box------------Type Filter Mater:.ial------------- - ; f __.__Depth Filler Material-------------------. ' 3 ou r _Distance to nearest: Well_ : ,- F ndation___ Property Line # •. � W - SEEPAGE PIT [ ] Depth-."- %'i fDiameter :___ r 4 Number------------- -----------------j z; Filled ' Yes ❑ No ❑ Rock Water Table,Depth-----------------` ---4 --------------------------Rock Size-----_:------ F h { Distdnc to nearest: Welll Foundation------------------------_.Prop. Line_________ __ ___ ter. - --- --- 1 REPAIR/ADDITION'(Prev Sanjtation�LPermit#_ Date �� - =� } r --v_v.. -. Septic Talk_(Specify..E2ec�uiretnentslidF p .-_. .•�' f2 --- -- ----- - ` -----------'---- ----------------------' l> Disposal Field {Specify Requirements}--------------- ---- ..--------- - - - ------ `�''� '��.Gi.✓ _ _----.l� C�4 �G ------------------------------------------------ ---------- , �.Ic -- --.gip- --� s,Er-•C_-irk-'.1{ , 9 ------ - ----- (Draw exisd g and required addition on reverse side} � hereby certify that I have prepared-'this application and that'the work will'be done in accordance with-San Joaquin'Coun ty Ordinances, State Laws, and Rulest and, Reguldions of the SanJoaquin Eo of j I q NX -. Flealth District. Home owner•,or-licensed agents signature certifies the following: �� +' �� "I certify that in the performance of the work for which,,this permit-is issved_al shcilkn'ot employ any person in such manner as to become subject to Workman's Compensation la "Moi,,C�hio�rliz:," Signe ner I d ' 'BY- )' =------ ---- ---------Title---- 14e V ------------------------------------ (if _ r on,o other thw } =--:`- '-USE--ONLY--- --=Fd 'QEPARTAI"ENTf APPLICATION ACCEPTED BY-------------- - - ----- - ---'--------'-- ---------- DATE.-�-.------?✓"��-------- ------------ IVISION OF LAND NUMBER.G-G-1-8--- --------_-----___--- - DATE ADDITIONAL COMMENTS ----------- ---------------------- ------------------------ ---------------- - --- ----- -----------------•--------------------------- -------- ------------------------------------------------------------ .Final Inspection bY:__=. _, e _ �. "t% ------ Date.-_ �__�.�� -------"- --- $ EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fes 21677 REV, 7126 ant r.hi