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FOR OFFICE USE- FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � f _ (Complete in Triplicate) Permit No....7 __' __ ------- ------ ....... Date issued..�`�_..._� .......................I---------------------------------. This Permit Expires 1 Year From Date Issued Application is hereb made to the San Joaquin Local Health District fora 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 ..`_.._ _,. ^�c ` �"1''`' ........f----_._ �/yIG --.CENSUS TRACT...................., .___ _. .. 2 C Owner's Name -----------9..x'1 (:f1Vf l _?-7 c�,c, Phone...................................... Address-----= s r r.. _'_..- .._........ _2------ --- --•-•---. .. ............ --------------Zip ....... - -•_-- CaC- .Ohl . (01 y .......»f''UO. . ` Y �. - jD .ZS" � � c� . Contractors Na �.e Phone._._.._................ ... - -- ------------- _ .License # ••-.... - Installation' wi f serve: Residence❑ Apartment.House.❑ Commercial jj;? Trailer Court ❑ Motel - Other: JI a Number of livte u i1 `V ' ` umber of.bedrooms:_0..'._._Garbage Grinder....:G3.. .Lot,Size_....._:�R``•�E-'__.__ j...- Water Supply:. P blit System and name:: ..-...;.:...... = --•.......:..... ::::: •--------------------•--•-- Private, t Character of s i[to a depth of 3 feet: Sand 5 Silt❑ Clay ❑.- Peat❑ Sandy Loam ❑. Clay Loam:❑ 4 ;-- �l Hardpan❑ Adobe❑ Fill Materia.l.. ..;------If yes,type...`---.----- (Plot plan, S,�_ (ing size of lot, location 'of system in relation to wells, buildings,etc. must be.placed on reverse side.) PACKAGE TREiA ION:(�(No sepic tank 'or seepage pit permiffed if public sewer is available within 200 feet,) A —` i 'f. ...Liquid Depth........-.-- _ __..- EW INSTAL A[MENT [ ) �EPTIC�TANK [;J' �- - Size.._..:.IV�'C__S::K=_��:._'_.�-___':_._...__ q J t Z _._.._r7 e__ �'�7O!`'T`: .Material _)�_! ............,IASr . Compartments........ .................. Capacit�--._-• Type- 1 i 2U( Distance to nearest: Well ....__,.LU.....:_........:.............Foundation.---.,l :..... Prop. Line.- - LI:ACHING LI„ E ,-.I ] . No. of lines___:::..-::: °. Length of each lins. ::._.� )-�.:.-____ _.._.Total Length...-----/t?--------------------- ----� V Box_'... ._Type IDepth. ✓•-_.T a Filter Material..._.i.�Z_�:._-.. Filter Material-----.--�...-_...................................:........... r Distance to nearest: Wel!_ _..f �'. i.._._.:_.._.Founiation....____�u_______________Property Line...._. .........._.__._._._.._. e _ SEEPAGE PIT!T i Depth................Diameter..:-..-.:__..._'-_-_Number_-- .......______________ Rock Filled Yes ❑ No WaterTable Depth... ..... ..........--•=-•--•-...... ----------- • --..Rock Size;--------------------.- .---.._...-------.------ ' Distance,o nearest:'Wel l ------------------- ---.- ...Foundation'--"..'-... ------ _'Prop. Line ---- ---•----------- Q REPAIR/AD ITtON( rev, Sanitation ......:......::: - -•---"-...........--=---_Date........=------••---------- ------------=----- 1 > �f eptic Tank (Specify Requiremen�to,\s) :: :•. '......... ......• -------------------------------- ----- ...---------------...... -- ........... } -MS, saI Field (Specify Requirements);_.,-•:;..-.:.- -`------------- ------------------ .............------------ ----- ' II . --- -------- ----•- --------- ------•----- - ----------------- r 9 (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared:this.application and that.the work will be done in .accordance with San Joaquin County Ordinances, .tate Laws, and Rules and Regulations of the SariJoaquin Local Health District. Home owner or licensed agents signature,-<erlhIfies the following: "I certify'7itu,' in the performance of the work for which this permit is issued, I shall riot employ any person in such manner as y to becotn subject bject to Workman's Compensation'laws of California." - Signed----- ----- ...................... _. .. Owner , -- -- Title " (I'f other than ner) Fqg DEPARTMENT USE ONLY i A�PLICATIO^IJ ACCEPTED BY.. .: ------. .DATE.,3 ...T 7 _...- D1ViON OF LAND NUMBER ............. DATE. _..._ :ADDITIONA COMMENTS _....... = ---- --•------ -----------••------ .. . ••-----•- ---------------------•---------- t -- -------------- Final Inspect----------------------- ---•-- - ..._.. G - — Date.--�-:/6-......__...._ ionby:.-•-----::.� ---. '..._--------------------=------�----._.....:.- - ..._..--•------•---_--,... ....._:....--•--•---• EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F85 21677 REV. 7/76 3M 1 - - . ce