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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �----------�'/ ----- ----------or-- Permit o. ��---- -�- (Complete in Triplicate) -------------- -------------- Date Issued.. -lr2._ 71 __-_------------------------__------------- -- This Permit Expires,j 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/LOCA N. -.--.- W� � - ---------------.CENSUS TRACT------------ - Owner's Name- -- ----- -- --- - ----- � f` ------ � --- ----------Phone-------------------------------------- -- ----- CitY. - - - e- �=-----------Zip---------- -i-----------------Address - 's Name - ----------License -----------Phone.1101 _ �l-zL Contractor / Installation will serve: ResidenceApartment House.❑ Commercial ❑ Trailer Court ❑ k "Motel F-1 Other----------- -------------------- -- --------- ii / Number of living units-------- -------Number of bedrooms._- _Garbage �GrinderLf ....Lot Size..7-S---.. - `'t'-- ------------------------ „ Water Supply: Public System and name------------------------ -------{---------------------------------- I---------- ------- --------------------------- ----------Private [�f Character of soil to a depth of 3 feet:� Sand E] Silt E] Clay ❑ Peat L] Sandy Loam ER--"C_1ay Loam El � 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.) / A� NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TAMC [ -1--------------- ----------Liquid Depth. _- x ` Capacity / TYpe _t�`. Matarial --------No. Compartments----------- --'-------------------- r / Distance to nearest: Well-------- ----------------------------Foundation..- —- Prop. Line-_ - ----------.---- - ra LEACHING LINE [ii�No. of Lines...--- --------------Length of each line_7 '!r p.�f Total Length.._/_A_.----- ___ - - 'D' Box-__ Type Filter Material_,)'' . _-_-. Depth Filter Material..../.- __---....__.........- ___Foundation_-_ ./.�- Pro er Line-_.. Distance to nearest: Well .-�`' F -------, P tY 5 SEEPAGE PIT [ ] Depth-----------'----Diameter--------------------Number._---------------------------- : Rock Filled Yes ❑ ' No WaterTable Depth----- ------------------------ -------------------------- Rock Size--------- ----------- ------------------------- .� Distance to nearest: Well-j..'""---�- ---------------------Foundation.-------.--------------1.Prop. Ling------------5--------------+. REPAIR/ADDITION (Prev. Sanitation Permit Date.:. ) Septic Tank {Specify Requirements)-------- �' �-- - ---------- -- - -�-�- - - - ------------------- Field ------ ------ -- � - DisposalF/ield (Specify equirements} -- �----- ��. ��A._ �' -- -------- -------- ---- ------- ---- ----- .� �-r-�[!}�` ------------------------------=---- -...- - (Draw existing and required addition on reverse side)' I 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, Fshall-not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed.--- - ---- f Owner '� -------------------- �! ----------------- --- --------- (if other than owner) rOlt PEP USE O LY r APPLICATION ACCEPTED BY-�:------- --------------- ------------DATE -------_-!_-- ---- 7/77 -- - -------- DIVISION OF LAND NUMBER.. -------- ---- %--------------- DATE. ADDITIONALCOMMENTS--------'---------- --- ----------------------- ---------- --------- - ------------------ -------------------- ---- ----------------------------------- -------------------- ------------------------•-- --- ---- -------------------------- ---------•---------------------------------------------------------------------------------------- -------------- ---------------I------------- - -------------------------------------------- ----- - -------9----------- ---------- Final Inspection b Qate y J� EH 13 24 �� SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21b77 REV. 7/7ti 3M