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r n FOR OFFICE-USE,. . ,, FOR OFFICE USE: 1 APPLICATION FOR SANITATION PERMITS-7 • i�•eG-' 7- a ------------------- Permit No."7-(---------- --------' (Complete in Triplicate)---------- 3 ` 7 7 -------i' ------------------'- 4 Date Issued--- -------------- -------- ---- ------ --------- --- ssued--___________________"--------_----_----"-_______"".__..__ This Permit Expires 1 Year From Date 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: `t� _ S"'--1------------- --pek- J hf-----------I AAA ----------.CENSUS TRACT----- 16-�---- JOB ADDRESS/LOCATION--.- :._ _� _ ___ _ ------------ �- Owner's Name. i I � = = r [�1Y��/1 ' C�'/1 - �: = Phone Address Ci ... Zip _----- Contractor's Name-------- ?, {� 1 /-a ------------------------------License # `' �ZQ. Phone' (c- -�.3.__. Installation will-serve:., Residence [�Aportment House.[] Commercial ❑ Trailer Court ❑ t I •=,' � � � � � Motel-❑ Other-=----- --:------ ------------ ---------- � .� ------ -- Number of living units__________ _____Number of bedrooms'_-�.-"_Garbage Grinder-.off !7' `Lot Size-_.--_1"_`7__-w�-__ Water,Supply: Public System and name------ _ = ----------------------------------------------------- - - -------Private.[� Character of soil to a depth of 3 feet; Sand,0 Silt❑ Clay ❑ Peat'❑ Sandy Loam*E] 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.) NEW INSTALLATION: (No''septic tank or seepage pit permitted�if public sewe is Failable within 200 feet) � PACKAGE TREATMENT SEPTIC TANK l[ ] Size--#- _ _ --Q__`- ___-_'--___"_____-__Liquid Depth `. eparity�4��- --TypE�I!__- Mater ial_C[/3`L Compartments--: { x� ( _ Distance tb nearest: Wel I_i_.___ _©f-----------------------Foundation,.___f._-- .___.___.Prop: Line___.-_' ---------------- LEACHING __`_-_____---LEACHING LINE' No. of Lines . ___"_____________",Length of each l,i�� - .., _-__-.Total I.ength P, . _ �, f'D' Box _-�r�''._Type Filter Material : __`Depth Filter Mat riaL___r - _ _ �. R� .,. ti :-gym ti �.„mom.__' �� r.r ;► e.r».• .ww. 1F / . jDistance to nearest: Well...50 -----_-------Foundation'__ l � ----------Property Line---------------------------------J¢ J --i SEEPAGE PlT _ pth___,.'-__Diameter--- - --Number__.___________ ______ r Rock Filled Yes = {�No � � ; �= . Water Table Depth. - - ------------------------------Rock Size ------ --------------- -------- --- Y- ,�, Distance`to nearest: We`11''`__-___ _ '__________________Foundation_____ __.____-:_.Prop. Line_.________ .__' ---___"_ REPAIR/ADDITION {Pr''ev-Sanitation.Permi#'#r- -::-------------- --------------------Date"-----------,---------------------------------- Septic ------_ ---_----- t ' - Septic Tank"[Specify Requirements) f --=--t--=------=------- ------------------------------------ =" Disposal Field (Speci#y.lZequirements): E ---- --------------------------------------- --------------------------- ----------= ----------------------- ----------------- ---- ------------ F1_. ----------- --------------------- ------------------------I-------------------- -------- ----------------- --------- '`��` (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application a_nd 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 thefollawing: t "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 to Workman's -Compensation'laws of California.': ■ Signed------- ------------- --<------ --------r--;, By-------- -----------------------------------=--------------------------------------------------------Title------------_-- ----- -------------------- (if ■ ------ ------ ° (If other than`owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED. BY____ f -------- '' '_DATE ___ 2- 7-- --- DIVISION OF LAND NUMBER.__ _ _ ------ f '° ._-DATE _.__ ' t ADDITIONAL COMMENTS----------- --------------------------------------------------------------- "._ ---- - --- 7 _ a _, ._ r x .. ! k ------------------------------------------------------ --------- ---- ------------------•---------- ----------'------------------------------------ -------------------------------------------- ---------- -------------------------------- - ---------- ------ P '00 '. Date r Final Inspection by:----- -` =- �= = ... EH 13 24 SAN J AQUIN LOCAL HEALTH-DISTRICT F REV. 7/76 3M f,