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*FOR OFFICE USE: FOR OFFICE USE: 3 G APPLICATION FOR SANITATION PERMIT s � -- (Complete in Triplicate) Permit 9�f -------------------------------------------- ------ -- -- ;,,,:r> . Date Issued_/e9-/46-_7 8' __________________________________________________ _____ This Permit EXpires 1 Year From Date Issued r Applicdhon_is-hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described, phis application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOS ADDRESS/LOCATION - - CENSUS TRACT. Owner's Name---------- V E , .... .t.... 5 -----------------------------------------------------------/ ----------- - 838-----w---q- v r4 -- Phone--- --- Z / -- Address---------------x"7-7'-�71-- -F�. /N- -- Ci FSCALv- Zip City.,, J p------. - Contractor's,Ndme------ -------------------------------------------------------------License #----------------------------Phone-------------.------------------_. -01 Installation will serve: Residence ❑ Apartment House ❑ Commercial F-1TrailerCourt Elf --Motel E] Other--kek-TI'`'------------------ f Number of living units:.-..../-.-------Number of bedrooms-9-.-.._Garbage Grinder------------Lot Size.......(77-/Z. ---------------- i Water Supply: Public System and name------ -- - - --- ------------- --------------------------------- ------ ---- -----------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material...- ----If yes, type-------------------------------- r F (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 is available within 200 feet,) PACKA TREATMENT [ ] SEPTIC TANK [ ] Size--------------------------------- --------- .Liquid Depth -------------------------- Capacity---------------------Type-----------------------Material--------------------------No. ...................... .Capacity---------------------Type-----------------------Material--------------------------No. Compartments --- ----------- -- ------ " Distance to nearest: Well......................._------.._.-.__--Foundation--------- Prop. Line_- .- LEACHING LINE [ ] No. of Lines---------------------- Length of each lines-------------------------------Total Length .-------------------------------------- ,//' D' Box------------ Filter Material__________________Depth Filter Material eria .------_--- . ST/ l�lf C /----- ---------- ' Distance�to nearest: Well-----5___Qr ...�'......Foundation---/0___.�.-......Property Line- SE fUlrvr ,r SE PI [ ] Depth------- ------Diameter........-..._.____.Number____.-___-.-._. ______------._ Rock Filled Yes ❑ No ❑ 7Xs7/A/01V�ater Table Depth. ti - Rock Size f Di.stan-cam to_nearest; Well------�I--------------------------------Foundation--------------------------Prop. Line-------------- --------- REPAIR/ADDITION (Prev. Sanitation Permit#------------------------------ -=:"' ='------Date-----.---------------------------------------.) Septic Tank (�peclfy Requirements)---- ---- ---- --------- -- ------------------------------------------------------------------- _ ------ -- --Dispos / _l ..___----- L .. (Draw existing and required addition 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. Home 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 not employ any person in such manner as to become subject t o kman's Compensation laws of Californi . - r Signed../ -------------------------------------------- - ner 5 By---------------------------------------------------------------------- --------Title------------------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. --- - --- ---- -- - --- - -- ------------------------------DATE.-- DIVISION OF LAND NUAABE .---------------------------------------------------------- - ------ DATE -------- - --- --- ----- - 0 ADDITIONAL COMMENTS----------- --------------------------------------------------- --------------------------------------------------------------------------------- ------------------•--.. -------------------- ------------------------------------- --------- --------- ----------------------------------------------------------------- ---------------------------------------------------------- tiy Final Inspection by: ----�--- - ------- yf ----Datel Q� � - EH 13 24 SAN(JOAQUIN LOCAL HEALTH DISTRICT rss 21677 REV-7/76 3M