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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FORS ANITATION PERMIT ' ---------------- --------------------- ------------- 7-7 /� (Complete in Triplicate) Permit No ff Date Issued ----- ------------ --------------------------------------------------------- This Permit Expires I Year From Da el'is`suecl V 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 Rule's and Regulations: ' JOB ADDRESS/LOCAT N ------- -�0 ---`'C" qrc --------- ------- CENSUS TRACT i � - Owner's Name.--- --- / 1Z ,L�a� --.----- ---- -- ----- ------ --Phone_36- w�c--------------- Address--------2-�------------ -- - City----- ccr.�-.. ZiP .r�! w - -- ------------------------------ - n Contractor's Name---Z11 J�..•---------------------------License #--3d�Agl-----Phone. Installation will server ` Residence [4Apartment House ❑ ,Commercial ❑ -Trailer Court ❑ Motel ❑ Other-------------- .: --------------- -- - � Number of living units:------------------Number of bedrooms_,_;_.--Garbage Grinder___----_----Lot Size-------. --- .+.o'__.--------------------------- Water Supply: Public System and name :: _ --------------------`------------ ---- ------------------ :--- ----------------------------------.Private , Character of soil to a depth of 3 feet: Sand ❑ -Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ -Clay Loam 14 4 Hardpan ❑ Adobe ❑ Fill Material------------ yes, type-----------------'-.----__._-.- (Plot plan, showing size of lot, 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 Ws,Vailable within 200 feet,) PACKAGE TREATMENT- Ca ac EPTIC TANK�� Size-_— -- _$_1L�___ --.---Liquid Depth____ _______ - ,p r l� �. p Y - � Type_ ,��pxtLLi�"IVo, Compartments--.__�_-----•------------------ Distance to nearest: We1.L ��-� - .- �� -Line-./aD-------------- 0 �O f ---._____Foundation.___ ' _-_- _____._Pror LEACHING LINE [t-�'No. bf Lines------ - ------ ..-.,-._-.Length of each line........... I- --- -------Total Length.:_..__l-�_,_.------------ m t - I � � S D' Box.lyy..Type Filter Material-/`j,e� Depth Filter Material---A.Z/22-�--------------------------------- ______--__-. . �• r { r ::,Property Line-- - r n Distance to nearest: Well If .- -'.- Foundation___ l SEEPAGE PIT [ Depth__ = --.Diameter.- .-_.__- Number-.- .M_________ ZRock Filled 'Yes� No❑'f ° Water Table Depth---J/A0--'--------- ------------------------.Rock . n _ Sfiize---�/-4----.z-��- % -------- ------------ .--------- ---- _ Distance }on ---------------------.Foundation---! � �------- -.Prop. Line W_t1 ` -- , REPAIR/ADDITION {Prey. Sanitation Permit#--------------- -- ----_--' ----------- ------.D'ate-------- ---.------'----= -------- } Septic Tank {Specify Requirements) -�r�--- --- -- s-�—----------------- f = = -------- Disposal Field (Specify Requirements):---- .."..". ". ._ . Z------- - lei ,- ' ------- ----------- - UJ .^(Draw existing and required_add.ition on,reverse„side). r I hereby certify that-.1 -have prepared this iapplication IcInd thatthework will be done in accordance with Son Joaquin Gaunty Ordinances, State Laws; and Rules ondl Regulations,,oF the San Joaquin Local Health District. Home owner or licensed agents signature certifies the following: "1 cern that'in the � ' fy performance of�Tlie work far which thiszpermlt ii issued, I shall not employ any person in such manner as to become subject to Workman's Compensation .11"w'!.of.. California.” Signed --------------------- B I ------- ..-_ �' --. --Title �v �r�----- ,f' _ .--., Own Y ; i 4. (If other than owner) f k 'FOR DEPARTMENT USE ONLY fF1 APPLICATION ACCEPTED BY------ -,. a ------------ ------------ --DATE --- DIVISIONOF LAND NUMBER------------------------ ---------- ------ - ---------7---- -------------------------------------.DATE.------------------------------ -----------= ADDITIONAL COMMENTS--- --- ...... ------- -------- --- ------------=---------------------------- ------------------------- ------------ ------- ------------------------------------------------------------------------------------------------------------------------ ------------------------------------- - --- ---- ------------------------ ------------------------- ------------------- ------ --------- -- - ---------------------------------------------------------- ---------------- ------------------------------------- ----- ----------------------- -- --- -----. ------.------ ------------------- --- ---------------- Final Inspection by:`�------- --'------ - - -- --------- -- ----�� -� gate EH 13 24'- � SAN JOAQUIN OCAL HEALTH DISTRICT F&5 21577 REV. 7/75 3M i