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FOR OFFICE USE. � t i FOR OFFICE USE: APPLICA31ON FOR SANITATION PERMIT . 44 --- -- -- ------- (Complete in Triplicate) Permit No. �'"_,_. '... Dt:te Issued. 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, 1 This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRl=551LOEATION p � � ... ,_._ 7 __.,1-- �� ' ._. _.:. _CENSUS TRACT...._;... _.. ..---- �I/ c /ff Owner's Name._1� ---....1TJ�.......... ................._ ....__ Phone__� -d .. n^ ..._._. . _. -,......,_ f-...... _._..........._._ City- ,�.- _ . ..._. ..................... ..:.... --Zip-,. Contractor's Name ��a ._!f' . 71�/ -..._. : ............:.......License a Installation will serve: Residence , Apartment House.E] Cornmercial 0 Trailer Court:❑ t i -Motel Q Other.__. -_-__.. -___-_1____-T----------- --- Number of laving units:._:._.: "-._.Number of bedrooms..... ...Garbage Grinder.......-.._Lot`Size------- .- - --" -" , Water Supply: Public System and name_.:.... - ... .... _::.:--r-, ._ y .. ._,.................................._.._.-- .. -..._Private -.. Character of soil to o depth of 3 feet: $qnd Silt Clay ❑ Peat L] Sandy Loam r Clay Loam [� Hardpan d Adobe. J - Pe - (Plot plan, showing size of lot location of system in relation to wells,buildings,etc. most be placed on reverse side.) L � � NEW INSTALLATION.-INSTALLATION.- (Nosepl'ic tank Mor'seepage pit permitted if publcc sewef is available within 200 feet,J .- PACKAGE TREATMENT ( j' ' SEPTIC TANK Size-------------.':...-_.-• -_..-- --____---..-_.....,. :.Liquid Depth..........................� kf # Capacity -"- . .._.Type,. .............. -------._Nay, Compartments........._................... t Distance to nearest. Wel1.,..,... ...... ........... Foundation......................... -.Prop.. Line......................... LEACHING LINE [vf No,of Lines.......li.....___.._.__._Length of each linr3. f3___ Total Length . ....... 'D .Box......1--Type Filter Materiol; lit !r ..Depth Filter.Material. ......... F D�stbnce to r crest.We].].� Foundation _�� .____._ ._.-:..Property Line------ ?"'____ SEEPAGE PIS 1< 1 Depth---- ._.___,.-Diameter--------- -_-_.....Number ....... ....... - Rock filled,,Yes.[] No crier Table Depth__.__: -Rack Siie.......... --______-_-. •-----___--- I i t .----- Distance to nearest..Well......... .............--.._Foundation-.----- ._.. _'...Prop. REPAIR/ADDITION (Prev,Sanitation Permit ...._....... _ -------- .. ....Dc3tq------ _ •-----=----------- j „Seo is Tank (Specify Re4,y.lreMents) = ................ Dispos Field (Specify,Requirements). --- ...1.�._ _... .. .. -----------._ ._._.._.. ...... ............... _. ....-.----- _-_-_._- ._ _ ......... ... .. ... __._ S ... .. y: - ... �. 4. (Draw existing and required addition on reverse side) I hereby certify that I have prepare pl this application and That the work will be done In accordance with San JaaquinCounty Ordinances, State Laws, and Ridea,,qpt Regulations of the Son Joaquin Local Health District, Hame owner or licensed agents. signature cerfifiee the followings c "t certify fart'in .the; o formunb of the work far wrh4h tails'permit is. issued, I shall not employ itay person in such manner as to become,•subject -tai -/ nran's•_Compensation.laws.of California." . . I _ Signed t 5 :._ -� :. Owner C.'-�' .e tx11rL�.. .. Title � By,�k ..._........_.. __. llf other than owner) TOR DEPARTMENT USE,ONLY . APPLICATION ACCEPTED BY....... .... ... .._ ------------------------ ----- DATE. . DIVISION OF LAND NUMBER._._...' DATE._-..-.-_ ADDITIONAL COMMENTS------------- .... _..._-.. ................... > ............ ............... ......:.......... ............. .1.._..__. _...-- ........ .. ............. ..__-__ • • 7 ^. . Fitnf-Inspection by._ •_ &�X> , - _._ a- Date ``� -I -- F85 21b77 REV. 7176 3M EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT