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r FOR OFFICE USE: OFFICE USE: APPLICATION FOR SANITATION PERMIT 76—r/.S 3 . Permit No-- ----------- - ---- ------ ------- ------- -------- -------- --- ----- --- (Complete in Triplicate)------------------� �_ \�x�... Date Issued_//.-�-7G-- This Permit Expires l Year From Date issued -------------------- --- ------ for a ermit to ruct and install the Application is hereby made to the SonJwith C untalOrdantancDesNot549 and d exist ng Rultes and Regulations:work herein described. This application is made in complianceY -- { t.. .. - .. 7 - CENSUS TRACT R JOB ADDRESS/LOCATION_... -. _.;. _ w�. Phone .3/-' f ! Owner's Name.. -_, ------- ------------ .--- _ ," i i - -- ----- `� :Cty Address.-�`�"-�1�---' -� =' " Phone - - ------- -------------- :.: License # - �`�' �w Contractor's Name-------- - , l e... ` r Installation will.serve: Residence Apartment House❑ Commercial .Trailer Court Other._ .- ----- =-Motel ❑ ` -- /. ?�l�amber of bedrooms`__.--Garbage Grinder.._ __.Lot Size " ' Number of Living units i '^� 1 ------ -------- --- _. .----------- ---------- ------"----- rivet Water Supply: Public System and name--------------------------- -----"- "-- e pp Y� ._ � t: �- r Peat❑ Sandy Loam ❑ Clay Loam ❑ Character of soil to a depth of 3 feet: i Sdncl ❑ Silt❑ Clay ❑ t Hardpan Adabo ❑-'"fill A7laferial___---___-- yes,type----- ` i �.. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) :i NEW INSTALLATION- ------------tank or seepage piF;permitted if public sewer is available within 200 feet,] SEPTIC TANKSize----------- No Co rtments_._ -' ------------------------- capacity - T _ w ---- Liquid Depth PACKAGE TREATMENT ["] " , m a p. ------ T e a_-:: = "- Mafierral- ---- ------------- p ,_ : i Ca acity " - Yp, ._.-- l i l �,. Distance to nearest: Well._:,. -=------------------ Foundation ._,_.. - Prop. Line_ -------------------------- to { C4 ' -.--.Total Length.- ------------------------- 'of - i .line � - - --- -- LEACHING LINE. I'1,.-. _ _ No. of Lines g... F ' De th Filter Material--------------------------------------------------------- - ten th-of eac . [ 'D' Box--: Type Filter Material- o p E ; ' . . a---- --- - --- -- Distance to nearest Wel! Rock Y N u da�fion ._ _ Property r m - � Diameter. ----------"- -.-- `' - Filled es❑ o Depth _ Number_ . SEEPAGE PIT ( l :. p. _. __ :.. � _ .. -------------------------- r Water Table Depth ^ --- --- '-Rock Size:_ Foundation---- ' ' -.Prop. Line-- - --- -' i - Distance,to nearest: W611 ------ --------- -------- -'--- �" i - f� € - f'D e.�----------- ----------------- REPAIR/ADDITION (Prev. Sanitation Permit ------ --------------- ---------- ------------ ' ---- Y3 Septic Tank (Specify Requirements) -, -- Dis osal Field (Specify Requirements)--- - "• 1 ----- - -- f ----------- Q - ------------------------------------------------. ------ = : , -- -------------------------- ------------------------------------------------------ . . _---.._. f Draw existing and re uired addition on reverse si 1 I hereby certify that I have,prepared-chis application and that:the work will. be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of thea San Joaquin local Health Distric oma owner or licensed agents signature certifies the following: "I certify that in the performance of the'work for which this permit is issued, l shall not employ any person in succi: manner as to become ct. to .Wor n's C pensation laws .of California." I r Signed------- _ .. ----- :. ------------- - BY----- ' (If other a., than owner) R PARTMENT USE ONLY; ------------- --------- , ' - DATE lr✓ { k APPLICATION ACCEPTED BY_...._____- " _ : a DIVISION OF LAND NUMBER -- -------------DATE. ----- - -------- :------- COMMENTS--------------------------------------------------------------------------------- ------------------ ADDITIONAL ---"--__"__________________________ ________________ ___________________________ ___.____.____.__ _ ______.______._"----.___.. __ __ _ _____________________________________________ Final ins . ----------_----`_------------------- - --------- --- - - - Dat Inspection.b �_ r F&S 21677 REV. 7/76 eN 13 24 SAN JOAQUIN L AL HEALTH DISTRICT \fy