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FOR OFFICE USE: ' FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------- -- - ---------- Permit No. $� 4 (Complete in Triplicate] �� ' ------------------------------ ------- --------------- i , .Date Issued_!9_7_4;�4�:_? I --------- --------------------- ----------- _------ ------ 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 Ordinance No. 549 and existing Rules and Regulations: T . pI � te __.U': NSUS TRACT.----BADONJO ;= Owner's Name--------- ---- -- ----------=-- ------- ------------------- ------- ---- ---- -------Phone------ ---- ----------------------- Z - - -------- Lf1 -City i Address-- ------------ c - ------------ P _ - Contractor's Name " -----------=--------License #_"32 ------------- Zz�b ---Phone-------'- ---------- ---------- Installation will'serve:. Residence [�t Apartment House ❑ Commercial ❑ Trailer Court ❑ _ _,� �, ... Motel..❑.. , Other e Number of living units:-.-_ �;.._" Number.of bedrooms----j'_._Garba.ge Grinder--------. ._Lot:-Size_- - _----__" ---------c-:- Water Supply: Public System and name- -=------------- --- -- ------------=--:---:------ -------------=-------------= ------ -------.;------------- --_- ----- Pri_ vtlt Character of soil to a depth of 3 feet: Sand [D 'Silt E] Clay El Peat ❑ Sandy Loam E] am Clay LoE] j - -�-. .--,.Hardpan_ Adobe.❑ .Fill Material___- - .._.Ifyes, {Plot plan, showing size of lot, location of system in relatioii'to wells, buildings, etc,must be placed on reverse side.) NEW INSTALLATION: } (No septic fank `or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK ['1 Size__--__ -1,,.• :�. `•� ------=------- ---i---------------------- -----Liquid Depth ----------------------------- ` Capacity---------------------TYPe-=------------------- Material---=-- ------- No. Compartments. ` V < Distance to nearest..Well..,._..--- ----------------- =-�Foundation ------------------------Prop. Line------------------------ . LEACHING LINE' [ .] Na. of„Lines-------- -------------------Lerlgth.of ........_'Total Length.--.---_---.:-----------=---------------- -- ,.� . j Material-. = Found"aeon Property Li - # -_______Depth Filter Material._"__ __ Distances to nearest: Well_=___.__ u + 'D' Box__.._.-"____Type Filter Mate #,'y Line . _ _ i I ro. r SEEPAGE PIT De th __. ___.__-- Diameter_____.--:___ , p _-- ---__-.N;umber---_--,--------------------------- Rock Filled Yes ❑ No. Water'Table,Depth--- ------------ ------------- --- - - ---- ---:.Rock 5ize- "Distarice to nearest: Vilell_------------------.. ------------- -------------------- Prop. Line--------------- -___. REPAIR/ADDITION (Prev..Sanitation Permit / - et --------------- .___ ' " Da4te__---.-.4--=2_16-7 . -- _2_'a_-._.--"--------____ _ ) _pifcReRri - Ds asal Field (Sp. Yequrementsl):p -- -- -- --------- ----'----- -------------- ----------`- --- ---------- --------- = . - ' - `7 r' !_ (Draw existing and required addition on reverse si ei� 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, I shall-not employ any person in such manner as to become subject to Workman's C nsation law f California." . Signed--;:------------ :--I------ -----! --- - ------ ------ ----- -- - - -------- Owner } ` ---- I itle --------------------------- --- ----- - -- -------------- By -h a ' If other t an owner) FOR DEPARTMENT USE ONLY, APPLICATION ACCEPTED BY = -------------=------'--------------------- - DATE../..a- DIVISION OF LAND NUMBER---------------- ------ ----------' : . . : ---DATE-•-- --------=------------------¢ ADDITIONALCOMMENTS------------ ---------------------------` -----------"---------------- ------------------------: ---------------------------------------------- ---------------- : a --------•------------------- -------------- ------------------- --------- ----------------------------------- n; ----------- --------------- ------- - + /// - ----- ------------------------ ---- O '-{------ Final Inspection b Date_- gas 2'b" REV. 7/76 'e SAN. 13 24 AQUIN LOCAL HEALTH DISTRICT