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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------- Permit No._J9___.41.Z_U . (Complete in T.i�ip�icafie} ------------------------------------------------------- Vn -'e', Date Issued-ur- a_ -7.7 ---------------------- This Permit Expires 1 Year Ficen`Date Issued Application is hereby made to the San Joaquin Local Health District for 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: j JOB ADDRESS/LOCA O11N----.-�-�`� ,�0------- da �i: � CENSUS TRACT - ' Phon Owner's Name.. ; _ .. ._ Address----------- Q : - .'City_.- - Z �+ T �- { C^ ® .' l_ Phone-, -------- - i Contractor's Name:.__ __License #- --"" .7 -- ` Installation will serve: t } Residence poo Xpartment House.❑ Commercial ❑ -Trailer Court ❑ t Motel ❑ Other g =- --- r : /2.._. Garbage Grinder :- --Lot Size------0.2 "-- Number of living units: s•-___ Number of bedrooms;. e Water Supply: Public System and`name .--------------- -_------- - ---�---/. - -_ Prwat Character of soil to a depth of 3 feet: Sand E] Silt 0 Clay Ll Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan EJAdobe:❑ 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.) i s NEW INSTALLATION: (No"-septic tank or seepage 'pit permittedif public sewer is availcible within 200 feet,) ` PACKAGE TREATMENT PI SEPTIC TANK' [''!' Size____►- >7�_,X- -------------- C tG------ -i Liquid Depth_.. J U T e.J -------- f Distance to.nearest: Well-----_- O. -.'----------------------Foundation----16 1__"__ ----Prop. Liinne_-._ ------------,-_- UNE [�No. of Lines-------Z- ,.Length of each line„--- -_-{-- Total Length -CPQ------------------------- LEACHING 'D' Box._ �ype Filter Material I! � �4`Bepth Filter Material-__ _I__--_.- f- -----"""----=---.`{ -- [ . � . . KGs. - - � .. , F -. - , Distance to nearest: Well___._5j_0------ Foundation---;A ----------- Pr.operty Line-------------- Number__._- '_____ l Rock Filled Yes No SEEPAGE PIT [ ]} 75 Depth------------- --Diameter----_--`---------- Rock - ❑ ❑ ---------------- Water Table Depth-___._______-- - �z ----------- c f Distance to nearest: Well ------------Foundation Prop. Line. = lPt REPAIR/ADDITION (Prev. Sanitation Permit f#------------------------=-------- ----:---------.Date-------- --- -:-:--- 1 -.-. -_of.. 7Z!re i k> __ ----------------------------------------- 7 -- - - Disosal Field (Specify RequirementsR); ;.._:- ----- ------------------------------- ------- �_-= .- - =-----------=-z_,. ---------------------------------------------- ---------- p #. Septic Tank [S ecif Re uirements)-____.__--._-_._.__"_.._ ______--------------------------------- -- __--_`.__-__ _____________________________h-�__:h.____ ____ --___------__ _ .-- ______-_. ____ -,---------------------------------- _- ____--._____-___________--_..-. f _________________________ _____________________F_..-_--_____-__-_-_-__------_______;_--___._____--________________________-_-__-__-_____--._-____-___.-__.____-- -�_-__._:__.___-__.___- (Draw existing and required addition'on reverse side) hereby certify that I have preparedythis-application..and-that-the-work will!,A; donein accordance_with San Joaquin i"County Ordinances, State Laws; and Rules and Regulations of the San Joaquin Local-Health District. Home owner or licensed-agents signature certifies the following: ' ro "I certify that in"the': perfarr`a,nce of the{work-for which this permit is issued, :I shall not employ any person ins h anner.as ' to become subject to . kman's . ompensation laws of California." Signed- ------ ---- ---- ----- ,-------- ----' --- - - t ---------- - --- ar Title____-__ l'�� -- ----------- -- (If other than owrierj r ! FOR DEPARTMENT USE ONLY. r - � "�cr / DATE.__APPLICATION ACCEPTED•BY . DIVISION OF LAND NUMBER------- ---- ------ ' . :: DATE------- __-. ----- --- -------- ---- ADDITIONAL COMMENTS-------------- ---------- - ------------ ------------------------------ ---------------------- ------------------------------------- --------------- --- j ----------------=- ------- -- --------=-------- ------ ----------- ----------------------------------------- --------- - ---------- } I : -- -.---- - ---- - ---------- ------- ------•--------- - ------ --- - �� ' �/ r Final ins ection b .. �rf�f y:..- EH 13 24 SAN JOAQ IN LOCAL HEALTH DISTRICT Fas 21,67 B �7176 inn p