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F01 OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - - i) (Complete in Triplicate) Permit No._-7-7_�-_6'33 Date --------------------------------------------------------- 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 compliance with County Ordi'nohce No.,549 End'existing Rules and Regulations: JOB ADDRESS/LOCATION-_SAN_ VrR^f Zi Ig �`verCl-C, A o-T___O_G/,jr--.CENSUS TRACT_________________________-__- Owner's Name--------cT 1 -0"I---------[7l-, i--1-� L'------------------------------- -------------------------- ------------Phone_V35-- p 5-_Ac Address---- ----30j470-0------ K"-5 Soo-----------------------------A dCity TyA e Zi Contractor's Name_-- t---A�_eIr_ D %Y _4 5R&A _ ---- p License #_je3L:_, 6____-Phone_✓-!Z�"__y'?�_`�__- Installation will serve: Residences® Apartment House ❑ Commercial ❑ Trailer Court❑ Motel ❑ Other----------------------------- ---------------- Number of living units:------1--------Number of bedrooms----f------Garbage Grinder------------Lot Size------------------------------------------------------------ Water Supply: Public System and name--------- R• C, _ _------ _ - ------ -------------------------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peaf❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe ❑ 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size---------------------------------------------------- Depth-------------------------- ��a Capacity -a- TYPe r_,C�sl ? -�- - aera -- No. - , Distance to nearest: Well--------------------------------------------Foundation-------/0____________-Prop. Line---I?s_-_____-_______V� LEACHING LINE [ ] No. of Lines 4r'X-4p '0_____-Lengfiti of each line.-----------------------------Total Length ______________________ Ta -------------- P/A_7r,>, Sed 'D' Box_________Type Filter MateriaL_�QG ____Depth Filter Material-___'i�'_C'_��__________________________________________:_- Distance to nearest: Well____ __-_:__ foundation__ 'Q_ Property Line SEEPAGE PIT [ ] Depth, ______._____Diameter_________ ________hTumber____________________________ Rack Filled Yes ❑ No❑- Water Table Depth-------------------------------_------------------------Rock Size------------------------------------------------ Distance to nearest: Well---.---------------------------------------Foundation-------------------------;Prop. Line____________________-----b REPAIR/ADDITION (Prev. Sanitation Permit#----------------------------------------- _-____--Date_--_-.____________________________,_________) .� SepticTank (Specify Requirements)------------------------- -_---------------------------- --------•----------------------- ----------------�--------------------------------- --------- Disposal Field (Specify Requirements) - ------------- -------- ------------- -----------------------------------------------------------_--------------------- --------------------------------------------------------------------------------------------------------------- ----- ------------------------------------------------------------------------------------------(� -------------------------------- ----------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------1� (Draw existing and required addition on reverse side) 1 hereby certify that 1 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed - /��19A, -6- -----� �®� - Owner BY - - => ------------------------------------Title---------------------------------------------- ------ n owner) F0Jt DEPAR NT USE ONLY APPLICATION ACCEPTED BY--- -- DIVISIONOF LAND NUMBER-------------- --------- -------------------------------------------------------------------------------DATE----------------------------------------------- ADDITIONAL COMMENTS -------------------------------------------------------------------------- - - - ------------------------------------ ----------------------- ----------------------- -------------------------------------------------------------- --------------- -------------------------------------------- ------- ----- ---------- - -- ` -- Final Inspection by ---- - - -- -- Date EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M