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FOR OFFICE USE: &16 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ____---_ Permit ----------------- (Comp ete in triplicate) k --------------------------------------------------------- � "" Date Issued__R' This Permit Expires I 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 Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/L TION 1 CENSUS TRACT---------------- --- i -- 11 i Owner's Name.. --------=---=------------------ -------------.--.- ..= --- ---- Phones i - -�- --- Address.4?-75�3---- --��- City - zip Contractor's Name------ - --------------- -------------- -----------t ------Licen se #_ 71 ,3 Phone s -- ---------- a Installation will serve: Residence Apartment House.❑ Commercial ❑, Trailer Court ❑ Motel ❑ - Other---------------------------- ---- ---------- F ti { Number of living_u6its:.....-/-----Number of bedrooms-77---Garbage.Grinde.r_...________Lot Size_- ��- . __------- --------------------------- "- Water Supply: Public System and Private Character of soil to a depth of 3 feet: ; Sand ❑ silt ❑ , Clay ❑ Peat ❑ Sandy a �a ❑' 'Clay Loam [] r - - -�- -�- Hardpan Adobe ❑ Fill M1atenal'-:-_q_..If yes, type_-;___......__."°`___"' (Plot plan, showing size of lot, location of system in relation to wells, buildings, etcimust be.placed on reverse side.) { NEW INSTALLATION: '" (No"septic tank of seepage-pit permitted if public sewer is available within 200 feet,) .J PACKAGE TREATMENT [ ] ' SEPTIC TANK [W s- -cZ. _� -------------Liquid D2pth _.o---________--------.W Capacity-I&d Type l Material }fes No: Compartments.'_ '----y---�- �-*------ ¢ Distance to nearest:.We11__:=_: . -. - -. -__Foundafiion--____�,7/ .: --:,-....Prop. Line LEACHING LINE Na, of Lines--------- __.-.- --.Length of each line.V0 Yo_ sf0..__.Total Length----"/Ra--------.-_--:-.- D' Box.___�Type Filter Material /_ Q.. -Depth Filter Material______ ..- ----------------- -- -------- Distance to nearest: Well-------5Z-..----- _...Foundation_.__/.0----_---"--.Property Line_?;-�?..___'!' ---"------� SEEPAGE PIT [A `Depth__pw"-----"Diameter_ ��..._._____Number-......-�_ _______---.---- � �� . Rock Filled Yes �" No❑ 1 Water Table Depth----------------1-Q--------------------------------Rock Size----717 X3-------------------=------------- + Distance to nearest: Well__.-------1--4--- ---------------------Foundation- p��......._-..Pro p. Line._45_-.fly__.._.. REPAIR/ADDITION (Prev. SanitatiomPermit#---------------------------------------------------Date------------------------------------------------- ). c Tank fy Destlosal Fie(IdpI(S(Specify Requirements)--IRequirements) - - --�---------'-""---- - - .p p � Y - - � ---- ff ----------------- r# (Do" iraw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work_.willbe done in -accordance with 'San Joaquin County Ordinances, State laws,4and 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 not employ any person in such manner as to beco bje t to W k mansi Compensation laws of California." Sined _ ► ------------------------ ---------Owner g ---- BY-------- -------------- — ------ -- -------------------- ---- ---- -----Title----- ----------- h------------------------- --------------------------- (If other tho o ner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ ------- �5,. - -- --- ----------------- -----------'---------�---- ----------------- DATE..----- '- --- --- -- DIVISIONOF LAND NUMBER.----------------- --- --- -------------� -------- ------------------------------------------------DATE----------------- - - ------------------ ------- ADDITIONALCOMMENTS -------------------------------------------- ------------------------------=------------------ ------------------ ------------------------- ----------------------- --- ----------- ---- ------------------------------------- --- -------------- ------ -- Final Inspection bY=--A 6' - Gf ----- --------- --------=----------------------------------------------Date-- eH is saSAN JOAQUIN LOCAL HEALTH DISTRICT F&s seen eev. 7/76 3M