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y FOR OFFICE USE: r FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT qq i Permit No.7-/-.:-...... j� ................O ...._..... (Complete in Triplicate) ZZ ...._... A Date Issued-- ---" a ....................�*.;.....1...-..... .....-- . �..,---..------------- This Permit Expires 1 Year From Dote issued Application is hereby made to the San Joaquin Local Health District fbr a permit construct d*install the work herein described. This application is made in compliance with Count Ordin ce No. 549 and existing Rules and Regulations: v. a �®� US TRACT.............. ....... ......... JOB ADDRESS/LOCA? - Ph - CENSUS __. :. - ------ - w L,. �. one. - Owner s'Name--. .;_ - -�- -. :,.. - : Lense Ph#- l �.-.- _ ne. .. Address: ` o Zip , i h U Contractor's Name__... 7G�1 ` Apartment House ❑ Commercial ❑ Trailer Court ❑ Installation will serve: Residence ❑ p —Motel ❑' Other_----- -------- -- ............. --- ----.- Number of living units:...::�--------Number of bedrooms...'f 1...Garbage.Grinder---- -......Lot Size.-- ;. - :tet, , . - -. Private Water Supply: Public System and name-_ --------- r _ ...y4 r e E Character of soil to a depth of 3 feet: Sand ❑ Silt-0 Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam *," Hardpan ❑ Adobe ❑ Fill Material--.--- ....If yes, type-..----------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings„etc..must be plated o reverse side.} NEW ,INSTALLATION: (No septic tank or seepage pit permitted if public sewer..is availdble`w ithin 200 feet;) C� id Depth.. ------------------- PACKAGE TREATMENT [ ] SEPTIC TANK -[.] Size.:..-J�.6_X_6 -x .................. Li iqu No. Compartments.. ............ Capacity /.{(00.....Type --------- Mataa -- {{ Distance to nearest: Well..- �q Foundation..... -.�...........- Prop. Line---------- �. - Total Length 9 _. �:f ------ ------•---- J LEACHING LINE [ ] No. of Lines . L`ength'of each`lins` .�.� == ”-- u f I 'D' Box. Type Filter Material...../ Depth Filter Material./ . ......Property Line------------------------ P Y Distance to nearest: Well..------•--------�--- .....Foundation._..-------•- - . Diameter-... ----- - Number..._:.-J------------•--- Rock Filled Yes� No ❑ SEEPAGE PIT ( ] Depth..- �. ,J - 11 Water Table Depth-----•--------------------- ---- ----------------_------ Rock Size -- Distance to nearest: Well--------- ---- ------Foundation_........... . .... Prop. ine:_--- ---------- REPAIR/ADDITION (Prev. Sanitation Permit#----------------- - ----------- ------ .............------- -----) --- ....... -Septic Tank (Specify Requirements)------------------ - ....... ............. - ...... ------ ------- -------- --------- Disposal Field (Specify Requirements) --------------�-•--- --------- ------- -_....... ---------------- • I ''---------------_------------ ----- - .............. (Draw existing and required additign-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. Dome owner or licensed agents signature certifies the following: "I certify that in the performance of the work for which this permit.is issued, I shall nes employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed----.... -Pon ----- --------- -- Owner- Title..............................:. _ Notowner} � FOR DEPARTMENT USE ONLY. -- ---- -----... BATE ......----------- -----� 7 APPLICATION ACCEPTED BY,;....----.-.-- � DIVISION OF-LAND NUMBER...........:.......... - �-••-•-------- -----�- DATE----- ------------• -- -. -- - -.°.-- --- --- ....?-------- --------- -------- ..... .......I...... . ...... ....... ..... ..... ADDITIONAL COMMENTS------- - ---- --- --------------------------- ---- ------------------- ........-..------. --------- --------------------------------------- ( -------------- V ...--- ------ � .... --- _ - -- --- ---••---.... --- Date. . � � � r ` Final lnspettion 6 ---'--' ------ -- ----- --- - - - --- --- F& 216T7 REV. 7/76 3N EN1324 SAN JOAQUIN LOCAL HEALTH DISTRICT f