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FOR OFFICE USE: FOR OFFICE USE: r APPLICATION FOR SANITATION PERMIT --------------------------- --- ---96 -------- --------- - [Complete in Triplicate] Permit No---- 7----------------------------------------- y ----------------_-----__-----_--------------------___._. This Permit Expires 1 Year From Date IslO"AN. 1 11) e Issued-.�_�: 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 Rules and Regulations: JOB ADDRESS/LOCATION-=-I a.-..S�---��------- --------------- -----� ,-,------ -----'------------=---------------.=.CENSUS.TRACT � ry Owner's Name...... - - .- --- --- Phone-- ----------------------------------------------------- Address 'd. .---�e.r1 .------- i --------------------City m � zip Contractor's Na"me--37�_Ig�t- ----------Ci 5. - license #_.. --------------•----.Phone--- --- ------------ r Bence MoteA Apartment Houma.❑ Co merci I ❑ Trailer Court, ❑ i ❑` P F� Installation will serve: Resid ❑ Other- _.. _.. . = ------ 9 Number of living units:________ _______Number of bedrooms_; Garbage Grinder....-_-.....Lot Size----4 -S-5•_.___._.__.__---------.----------- __- Water Supply: Public System and name = .. ---------------------------------- ----------------Private Aa w Character of soil to a depth of 3 feet: Sand ❑ Silt❑ 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 placed on reverse side.) s NEW INSTALLATION: ',(No"septic tank or seepage pit permitted if public sewer is available within 200 feet,] 0( PACKAGE TREATMENT [ ] " SEPTIC TANK Size_-� -�� .. ---------Liquid Depth._.y_____.__..___-t'1 �j Capacity-jXd&---------TYPe 'O _L___Material._ ---------==----No. Compartments.... L--------------------------- Distance.to nearest: Well--=-----=------ ---- „___ ,_._„------- Foundation Prop. Line LEACHING LINE �r] No. of Lines------- .---------------- __'__.Length of each [i.ns._-�� --- ------------------------Total Length._..'y0 i D' Box--?'> ----Type Filter Material-.-- '-----t-----.Depth Filter Material.--�.Q ______________________________________________ Z6va4-fr Distance;to nest: Well_]_/ __._'.____..____.Foundation....�.�______________-_.Property Line-d------------------------------- ,jart ] Depth w �i T Dept -.--.Diameter. $'�.-.__- -_Number.._...... Rock Filled 'Yes No Water Table-Depth---. ___/_ -'6--------------- -------------:------ --.Rock Size �- ------y------ ------------------- Distance to nearest: Well--- + --------------------------s-----Foundafion__ _.__.--------.-____ ---- --.Prop. Line-.- ------ - REPAIR/ADDITION (Prev. Sanitation Permit#- '_ - '- :'--_:-_-___________. Date._.: _________ __.______] s Septic Tank (Specify Requirements)_--'- :- ._;:----------=------- = = -------------------- -=- -_-------r=_----------------------------------------i Disposal Field(Specify Requirements). -----= ---------------------------------------------------------------:----------------------- ------------------------------- ------------- -------------------------------------------------------------- ------------ ------------------ - ------------- -------------- --- ------ { : -------------------------------------------I--_-___-_.___F___.___.___v._____.___..--.-__--.-_---_--.--.------.-__.___-------------------------- _ {Draw existing and required addition on reverse'side] ' I hereby certify-ihat.l 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 becom u�bjec�J to Wor an's C pensation, Taws of California."... Signed- - . -.--- --:.:-. ---. --- -- By- ------ --------- - ----- OTiwtlen-e-r-- -- = (lf i other than.owner] ; . . FOR DEPARTMENT USE ONLY' t APPLICATION ACCEPTED BY = -=--------------------------- DATE. . . 7 DIVISION OF LAND NUMBER ---------------------- =------ ----- ----------------- ------------------:--------- ------------------DATE. ----------- .._ ADDITIONALCOMMENTS---------------- ---------- -------- ------------------------ ------------------------- -------=-----------= ------------- -------------------_------------------------- ------ i2------ --------------- _ ✓, -- - ----------- -�----------^-------------------------------- -----------------------D--a--te--:----`----:-�---`------------------ -----"------------ 7 ---- --_ -----_ --. _ x ------------- -------------------- ____________ ----- ---- _ _ -- --- - 7_ �----------- ------------------------------------- - ._ c - ----------------------------------------- Final Inspection b-- - EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7/76 3M