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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: - (Completelete inTri l'cate) Permit No.-�6' 3.7 r ------------------------------ - -- This Permit Expires 1 Year From Dateissued Date Issued--F-7/-7� 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 d Regulations: ._._. .P.. .... ,_ . JOB ADDRESS/LOCATION.,...___ _.-__-_� _s CE -"-�-r z .. NSUS TRACT.•-- ` - :r Owner's Name---------- -- Address---- �- - on S l 1 " _ -- ----City- y I P e.. - �- , Contractor's Name__ -- - --- --------- - License .#,_ Phone.'-- ------------------ one. -- C_o-S Installation will serve: Residence Apartment Nouse ❑ Commercial ❑, Trailer Court ❑ ,. .. . ..�. Motel ❑ Other__` - ----- -------Number of.bedroms-.Number.of living units:___ o __-Garbage Grinder_._ Lot, --Size_------- - ' -- - -- Water Supply: Public System and name-_- --, .-:_.- _ - _ Private Character of soil to a depth of 3 feet: Sand ❑ Silt i Cla ❑ y Q Peat❑ Sandy Loam'{❑ Clay Loam ❑ P ❑ . . ! [ Hard an Adobe Fill Material_-.- ----If yes, type-. _---`" ------------------ 3 r (Plot plan_show,ing size of lot, location of system in relation to wells, buildings, etc. must be`placed on reverse side.) NEW INSTALLATION: (No se'tic tarik or see a�a ,t "` 1 x P seepage p'r permitted if public sewer is available within 200 feet,) Of W PACKAGE TREATMENT [ ] . SEPTIC TANK [ ] �, Size'"".".- .----_- - =-'=---"° ----- TL-iquid Depth.-- ------ � Capacity__—_ -=__ ��TyPe' '- --Material__-.�------°----- --------No. Compartments # P ---- -- Distance.to nearest: Well.__----:,; ------------ Foundation ---------------Prop.o Line--------------------- LEACHING LINE' ['] Na. of Lines_. -:Length of each lira. =. -' ------__:, Total.-Length. _ . . ;D' Box -Type Filter Material'_ _.--------------Depth Filfer Material_. - Y • y Fo da ,Distance to nearest: Well.:--_ z' Property Line... ..• } un_ ton -- --- - �-----<--: - � _ ------ - Diameter-------- ------ SEEPAGE PIT �._ I ] Depth. Number--------'= --------------- R Y t Rock Filled es ❑ Noy❑ Water Table De th :' Distance to nearest: Well-----------------------=----- '---------- - =-----^-- Rock Size-'---- `--------- � " f p l -,Foundation---------= Prop. Line: REPAIR/ADDITION (Prev:Sanitation Permit#___________..__ t =------------ ] ------------------------ Septic Tank (Specify Requirerients)----------- ------------------------: Disposal Field ((Specify Requirements) --- -- ----'_--�- - - i � • : ------------------ l� .;.: .------ - - - -- ------------- ------------------ -- ---- j [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.-.1 shall t employ any person in such manner as to becomes e t to W man' Compensation laws_of California.".. . i_ Signed - r - ..= ' Owner ------ BY-f----------------------- ijrF - ---- - ---- --Title. -- __ • � - (!�01 ther than own - - '- FOR.DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ._-_-__-_ - .DATE._.____ l DIVISION OF LAND NUMB -- --------------------------------- :::.: _ --- - ------------.--DATE----- ADDITIONAL COMMENTS------ -----: --'------- -- -------'----------------=------:----------------------- i ----------- ------------------------------------------------ -------------- ----- ------------ ------ -- , - -----` Final Inspection by :i _. _. a - ......... -- --Date -- � - - - EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21 77 REV. 7/76 3M