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FOR OFFICE USE: ' FOR OFFICE USE- APPLICATION APPLICATION FOR SANITATION PERMIT ------- ---------------- ----- - No---- (Complete ��- CS/ i in Triplicate) Permit ........... ..... --------------------- - - ---------- S-//-7v �.: Date Issue --- -------------- ---------------------- --------------------- ------------- This Permit Expires 1 Year From Date Issued v 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. 349 and existing Rules and Regulations: '. JOB ADDRESS/LOCATION...' `Q O.:7 t - ---:7�?* e- 47 ------------- ------CENSUS TRACT---------------------- ------ Owner's Name 5 ..�1��l ? l� ' = ----------------------------------- --------------- ------ Phone ---------------------- -- ' �'f11 -------7'- .R, ».,T......-r. .. Address.---'-- � -7-------- - - -"' ' C~��-------------:---- --�- ----- rCi /�C�_--: -------------------Z'P-------------------------;---- Contractor shame, P19 �t.l�T !-�----,EA'9r--1---�'-.__'_License #---3 4:�.9,1a9-------Phone:-441"-JVS ... Installation will,serve: Residence [y Apartment House.❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other_-, ---- Number of living units:____...........Number of:bedrooms-..----44---Garbage Grinder- _____:.Lot.Sizer%.71nAlri S�� a iAfrl'.zQA Water Supply: Public System and:name---"------------------------------- ':: - - _--- Private Character of soil to a depth of 3 feet: Sand E] 'Silt E Clay E] Peat 7] Sandy Loam E] Clay Loam E]5 Hardpan ❑ Adobe. Fill Material-____- -If yes, type ..__.____--___.-_.._... 1 if F (Plot plan, showing size of lot, location of system in relation to.wells, buildings,•etc. must be placed on reverse side.) NEW INSTALLATION'--4.(Na! septic tank or seepage pit permitted if public sewer'is available within'200 feet,) } Silt ___.____._.PACKAGE TREATMENT SEPTIC TANK ------- _ i Capacity- ��Q-0-- -,Type---== -------------Material...-- -:: .No: Compartments- - N -.::Distance.to_nearest:.We[l.--------/0AP------------------------'Foundation.{. ---- E-.---.Prop. Line- - ------------.W ! LEACHING LINE' No. of Lines-:-- Len th of each line- �Q_'.._.. �___Total rLength _t_,3� -i-------------------- :. ... g �3 r 0,4f py y f D' Box- -x-....Type Filter Material.. oft _-Depth-Filter_Mater:ial..:---17----------------------------------------------- Distance to nearest: Well..-_1Q d______________Foundation__--13.............../..Property'Line----£"G --._-- ' SEEPAGE'-PIT• [ ] Depth----r----------Diameter-Ji-----t_zf�--7---Number--- -----------------------------4�' 'Rock Filled Yes ❑' No❑ .-.4�- _ Water Table Depth------------------------ ---------------------------------Rock Size.. ------- t G0] Distance to nearest: Well.. -=------- ---------=---------Foundation. �_ _________ ------Prop. Line...__-------- REPAIR/ADDITION Prev. Sanitation Permit# --Date- '_ ------------------------------------ -- �_____________ ______ h J Septic Tank (Specify Requirements)----- .GOA � ..Gr .... .- ._.. y.. Disposal Field (Specify Requirements) L,�t--q0 i��;/�-�- �� -L-/-'-�"�'�------- --------- -------- ----- -------------------------------------------- k a .. -------- ----------------- -- -- ----------------------------------- ------------ ------------------- r-------------------------------------------------------- ---- - - ! ---------------- f (Draw existing and required additionon reverse side) I hereby certify that.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: P "I certify that in the performance of.fhe work for which this permit is issued, 1 shall not employ any person in such manner'as 1 to become 's lett to Workman's Compensation, laws of-.California." Signed -- ; --- ..------ -------------------- ----Owner V. i �. By --------------------- -- -- ----- T'tle ' (If'oth& than owner) ` FOR DEPAR MENT USE ONLY 3 APPLICATION ACCEPTED BY-.-.., --' = = DATE..----- '7 DIVISION OF LAND NUMBER: =------=---- :. DATE = ADDITIONAL COMMENTS-------------------------------- -- t ----------------------------------------------- --- ----- -----=-------------------------- -------------- ----------- ------------------ ----------------------------- ------------------ ----------- ------------ ----- ---- -----'-------'----------------------------------------------------=----------------------------- i I - - ----- Inspection b ¢ ----`------------=----'--=='---Date Final,Ins - p y:-------�-' - EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT -- _ ,r8s-21677 REV. 7/76 3M -