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FOR OFFICE USE; This Permit Expires I Year From Date Issued Date Issued-6- APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: ....- (Complete in Triplicate) Permit No..7�r_:.l . i I 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 co/mpl/i�arnce with County Qrdinance No. 549 and existing-Rules and Regulations: JOB ADDRESS/LOCATION://_'1A j t ... CENSUS TRACT...--t-�---- Owner's Name..-.. --- .....-�- Address- �, . ..-../� ` f .�! ............. one .. _ -- _ = _ Contractor's Name---- -- .. - -------------- -- � P- -�a-�-L ---�--•-- f }`$ . . ..License #-------- - ---------- ----Phone ------= -------------------- Installation will serve: Residen e 'Apartm nt House ❑ Commercial ❑ Trailer Court E]r Motel [.J Other- ........ --- ---- ----•----...-•-------- r� Number of living units:...._!.........Number of bedroo s._ i ` g .. .Garbage Grind er .-_Lot Size___.. Water Supply: Public System and name Character of soil to a depth of 3 feet: ;.Sand Si �' Private . -- . i , ❑ ; p ❑ It -j C`la`y❑ Peat[ Sandy Loam ❑ Clay Loom f' Hardpan Adobe C) Fill Maierial.. .... ... If est e------------------------- .Y {. /Y YP ...... (Plot plan, showing size of lot, location of system,in e'lotion to'wells,,6uildings, 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 TANK4 ""� [ ] :, Size.... lz.oi�"`"--'�,, -----Liquid Depth.- ---- Ca dcit //-- P Y/lam _ T eDn Yp8 gib.-./Material-�1 ,No. Compartments_..._ Ca ` _ �------------� -; �.+_� Distance to nearest:Well_.,;..___. ..!�.� -_--.....Foundation....... LEACHING LINE �b-,. . Prop. Line---�Q.G3._�-....� . ( 1 No. of Lines- _3- - -- .- ength_of-eac line _. - ..®... :.......... Total Length ....-fr Q_ ` M� 'D' Bax.../.-..... T � 1A74. �1 ype Filter Material__ -- . - Ater atenaL-..- -9---- .------•---- Distanceto nearest:. ...--- inundation--., ----' -- f SEEPAGE PIT / ��Y ...-Property Line--/G4__ ---.. [ ) Depth. -_...Diameter.._ .3 --..-..Numbs"r-...-- _ t Rack Filled Yes_ No•� - I .r — ..f ------- -io ....Rock 5i ,,.?.� q � Water Table DepK------- J �c_� __.-.... -- Distance to nearest: '------- Prop, Line_ _----- REPAIR/ADDITION f Prev. Sanitation Permit#....... ..........._-.--.-.... -- r -- --------Date -- .---- -------- - -�......- --- ) Septic Tank (Specify Requirements).... t--- - ------------------------ ........ ---- ------ Disposal Field (Specify Requirements)....r.........:..:.... ' ----• ----------- ----------- --------------- .... ..... - --- .......................... (Draw existing and required addition an reverse side) OI hereby certify that I have prepare6his application and that the work will be done in accordance with San Joaquin County rdinances, 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 i e performance of t ork for which this permit is issued, I shall not employ any person in such manner as to become to ork an's C �, ,sation laws of California." Signed-k- - -Owner BY ---•----- ------ L�__ --------------------------- ..-.- Title.-- ..... (If other than owner) 1R DEPART NT USE ONLY APPLICATION ACCEPTED BY._._ .._.. i, ......-DATE G 7� ;....__..... DIVISION OF LAND NUMBER----------- -- ----'-.---.------ - - �...i.,-� .• ----------- • -- ...... DATE......... .. . ....ADDITIONAL COMMENTS... :.[•.tea.-.o/G.- �•3r�/��+ �',/j f . -------------------- ............. .. . ....................... .. .. .. ... ...... . ----- -------- ..............- ---.- --- • ---- ------ ---------- . .............. -- 4 Final In by------- �. ----------------------------------------- ------ - ------------ --- .. .-- ......}_. nspectio --------- .- --Date---7f-11----_ ___ :H is ze � N JOAQUIN LOCAL HEALTH DISTRICT F8S 21677 REV. 7/76 3M 4