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T 0- l� FOR OFFICE USE: „ FOR-OFFICE USE: APPLICATION FOR SANITATION PERMIT ' ------------------------------- y p p Permit No.._77--�`.� i (Cam lets in Triplicate) I ------------ - c� ��-77 Date Issued-.._1- R _------------------------------- This Permit Expires 1 Year From Date Issued ..ter�..- a- - -�- - .{ A4A. • T oa ui Local Health District for a permit to construct and install the work herein described. 9 Application is hereby made to the San.J This application is made in compliance with Co y Ordinance No. 549 and existing Rules and Regulations: : ` CENSUS TRACT - JOB ADDRESS/LOCATION---- Q -- - - y �' ------ l Phone__ ��_ Owner's Name-------------- --------- . .. - - - -- --- --- -- ------ -- Address-- -- - ------------ . - --_ ---- -------- ---- ----------- �3 n � n C�rc1J� � City `- Zip " Contractor's Name.__�c.!��- � AS!Ae_` `s.Jo. � fly-------License # Tom- e 7 s Phone Commercial,�, Trailer Court Installation.will"serve: ;I Residence,f Apartment House.❑ ❑ : .Motel ❑ - Other------------------ -- Y 'f ' c.a- J w-= -----` - Number of Jiving units:,_1j._.'---_-Number.of bedroo --_--Garbage Grinder. •. Lot Size._ , . r g 1 { -- Private rel • Water Supply: Public System_ -and name....'------------------ -=------ --------- ----------- I ----- -- 4---- -- 9 l. Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam �] Clay Loam X r O 'w Hardpan ❑ Adobe Fill Material__.-- ____..1f yes, type___ R f _- _.- `-_ i a I (Plot plan, showing 'size 6f'!L at, location of,system in relation to wells, buildings, etc..must,be placed on reverse side.) NEW INSTALLATION:' "(No septic tank ;or 'seepage pit permitted if public sewer is available within 200 feet,) ,� ."!"""`."�.,w,Size----- - ± �`; -----------Liquid Depth ------- ------ PACKAGE TREATMENT "[ ] � SEPTIC';TANK [- ]'" ----•- ------------_ ---------=--- �-� ` ------------------------- Capacity-== i- ------------:'Type--- ------- --=-- Material--------------`------ =°__No:;Compartments"- ----- E ..Distance'.to nearest: Well--------=---------------------------------Foundation-_J------------,.,_s`--.Prop-Line--------------- --------- --------------------- ----.Total ----- . . . ..... �z' _.T al Lenygth .,Na. f Line : .-LEACHING LINE .. . ..Length of each line.:-- --____-- .-- ---VD' Box .-- --Type Filter Material :--- -------Depth Filter Materia ------------------------- ------------------- . --_-- -- '--- s -- Property Line - - -------------__-_-- Distance to neaest: Well- ------------- ------Foundation- 4 Rock Filled Yes p l -- r--- ------'------------ - ❑ SEEPAGE PIT [ ] Depth---- ------ e th.-- Diameter. -Nbe Water Table,De th--------------- '-------------=- ----- --------- Rock Size 4' ti I to nearest:'Well_ ------------------- d = ---------- 'DistanceFoundation �' .Prop. Line i REPAIR/ADDITION (Prev. Sanitation Permit#-__._--- --`--- ------------------_------------ Date. = -`---------------------------------) Septic Tank (Specify Requirements)------: 7 ==---=------- --- --- 4 ----------- Disposal Field (Specify Req`ire nts) } " =------- ------------------------- ' --- ---- ------------ "_ 4 3" �C • '_'_ -- - -- - -- ------ - . ---- -- ------ _ --------- -------------.---- '" fprow exis'tin and equired 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 Ordinances,• State Laws, and Rules and Regulations of'the_San Joaquin Local Health District. Home owner or licensed agents signature certifies the following: "! certify"that in 'the erformance"of the_work for which this permit is issued,'l shall not employ ariyTjserson in such manner as to bet* subject o orkm n's Co nsation laws of .California." _ } Signed 5 I I g, 4 Title. - - ----- -- -- (If other than owner) r r' FOR DEPARTMENTUSE ONLY w DATE' APPLICATION ACCEPTED BY._-__ - _- DIVISION OF LAND NUMBER--------=------------- - --------------- DATE-... ADDITIONAL COMMENTS.----------- ------------------ ----=.------ -= -------- ----------------------- - l ---------- - ------------ f -------------- --=--- ---- i ------ - ------ --- -"------ - - ---------•---- -------- j -------- -- - t / 6..- Dae - /= ----------------- FinalInspection by:r� ---- _- -- ------- ------------ - - - - - - - --- ---------- --------------------------------------------- $.. EN-13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 216 76 3M}