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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----- ----- ---------------------------------------- - {Complete in Triplicate} Permit No.-,7r7--F'9,2----------------- ------------------ - ,, �� Date Issued_,01-`,_;26_-,7�� ' -------------------------------- ----------------------- 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 complion�ce with County Ordinance No. 549 and existing Rules and Regulation: JOB ADDRESS/LOCATION ,5'�..�'1�5 " `- CEN TRACT -------------------- ------------ •----------- . --- US 5 Owner's Name- /4 K/f.- <_r-... " _ Phone µ Address----------------- '_.Z __._ - City-... .:. . -'`" ``--------------------Zip------------------------: Contractor's Name--------------- ?!�'- C License # - - -- r-�--Phone Installation-will serve: , Residence [ Apartment House.❑ Commercial ❑ Trailer Court. ❑ Motel ----- - -.,�-.,--�F•' ,�,,; �❑-"..�0#h r`�. Number of living units:. _ -_Number;of bedrooms ._ ---Garbage Grinder___---_-_- Lot,Size-.-A - --.• i Water Supply: Public System and name---- -.--:.------------------ ----------------- --------- -- € --------------------------------- Private ❑ Character of soil to a depth of 3 feet: Sand ❑3 Silt ❑ . Clay ❑ Peat❑ 4Sandy Loam [ Clay Loam ❑ + ' Hardpan ❑ Adobe;❑,' 'Fill Material �lf yes,_type----- --—--------- - ---_- - (Plot.plan, showing size of lot, location of system in relation to.wells, build ings,,etc.'must be placed on reverse side.[ d NEW INSTALLATION: '(No.'se 'tic tank=or sees g pit permitted if public sewer is_ayailable within 200 feet,) .� PACKAGE TREATMENT [ ] .—SEPTIC--TANK"[�J # ` Si of 1 r q �C' ( e Liquid Depth..-.q' ----------------- t -¢ Capacity -Ape __Material--{0-±�'� �."---No. Compartments--------'�------------------� Distance to nearest: Well '--'---- 4 _,... :......... �_: :,_=-=-==Pro Line---- �------------------' ndatio'n_-___-�, __ LEACHING LINE/ [J] No.,of Lines.:,..•.._`-__ --- Lertigth-of-each Lina----------6p *_-__..._.Total Leng/h.:-----1.7-------- ------------ i `'D' Box ..:__Type Filter Material_____-S p -- '_-- _De th Filter Material- -- �'�-.-- --------------------- .. . y Distance to nearest: Well _-4 .----:.- _Foundation...:._._1 _____ _Property Line--------Z--------------------- 41� [ De th---�2^---- aLer-`----'-- - Rock Fi11ed 'Yes No [ ... p P- ------ ----- � Num er .__ P I �- - �'�:.��----=------j --_.-FouridatSize---- � l� X-�"�----------------------- T ' -"---------'-- � Water Table De th.----------•---- ---------------------- -- -- m � _ Rock . Distanceao nearest. We I on_-.--- � .__..._-..Prop. Line__ ---_-.----- , - . ' REPAIR/ADDITION [Prey'Sanitation Permit-#- ------- = -------- - -----'Date--- -- ------------------ -------- Septic ---'-- Se tic Tank (S ecif Re uirements)----- "- - ) ------ -------------------------------- ' 4 Disposal Field (Specify Requirements)-------------- ------- ------------'-------------------------------- --------- --------------- -------------- ------------------------------------- -- --- -------------- = ,__-.---- - _ ------------- R _ (Draw existing and_required_addition on reverse side) k I hereby certify that'l 'have prepared this application-and that the-work will r 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: f "I certify that in the performance of the work for vi+hlch"this permit is issued, I shall not employ any person in such manner as to become subject to.Workman's: Co ensation .laws California." Signed -- ------------------ ----- . - - Owner -- - - arl for ' [If other t an -owrier) ",FOR-,DEPARTMENT USE ONLY 1. APPLICATION ACCEPTED BY -�:--- = --- ------ ---------------------------- DATE 6701 ? DIVISION OF LAND NUMBER ------=--.---.-------------- f ---------- -------- - DATE 4 ADDITIONALCOMMENTS---- ----- --------------------------- --------------------------------------------------- ------------------------ --------- ----- ----- 4 ----------- ----- ------------------ - ------------------------=------------- ---------- ----------- -------------------------- ---------- i incl'Inspection b Tom. Date.---------- --------- •2-- -- --- ------ P y: --- - - EH 13 24 SAN JOA IN LOCAL HEALTH DISTRICT F&5 21677 REV.7/76 3M