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FOR OFFICE USE: - FOR OFFICE USE: } APPLICATION FOR SANITATION PERMIT ----------- ----------- --------------------- Permifi No._-�77_�:7,57 , -------- (Complete in Triplicate] -------------------------- 1 /�77 ------------ ------------ - Date Issued..]------- _-------------- 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 Regulation w s �. i '_- •- �. : J :CEN S US TReACT,._ a/- --�- - --- -- -.. ... JOB ADDRESS/LOC � � -/�7�.�� _ Phon - --------- - —� }.:_, --------------------- Owner's Name#_. -- - � S - , --City Address._ Contractor shame ----------�1�1-�------- --- ---- ------------------------------------ -- -License #----------------- ---- Phone--•----- ----------------------- CIO ------- ----. Commercial Trailer Court Installation will.serve: � Residence��r Apartment House.❑ ❑ ❑ . t Motel ❑ Other "" = --- -- _---. s , Number of living units:._.__.-_'-_--__Number-of bedrooms--�r_,_Gar_bage Grinde•r_-_-___-_-_Lot-Size-__ T-8:- ---------------- Y i - Private Water Supply: Public System andname: -- 1 ______ ____ _____ _ ____ _ - - 4 Character of soil to a depth of 3 feet: sand ❑. ^ Silt L] Clay ❑ Peat ❑ Sandy Clay Clay o m ❑ p ❑ ` be 7 Fill Material-----.----.-If yes, type ,'x�f Hardari Ado" fl' : (Plot plan, showing size of lot, location of.system in.relation to.wells, buiidings,:etc.rnusbe placed on reverse.side.} NEW INSTALLATION: _(No septic`fank`or seepage' pit permitte� if public sewer is available within 20o feet,f - = _.-Li uid Depth--------------- ---- PACKAGE TREATMENT [ ]' >-SEPTIC-TANK -------------------- q p '.Mixterial ___-- � No. Compartments --_.__ ---- --- I }. .Capacity - _...__. ._ 'Type : Distance to nearest:.Well ------Foundation Prop. Line i - LEACHING LINE [ ]... No. ofwLines.`........ __. `____ _- :.Leng h of ea�i a:iris- y,_ -:- -.Total Length.- -'D' Box_— -.-^._Type Filter al'---- ' ---- -..epth Filter Material .... .._...v F.. 4 } fP -- Distance�#o nearest:We I - �_FJo un8 afi n___ _- __ operty . �- ; t ' ` �Il N ❑ SEEPAGE PIT [ ] depth.-_ : Rock F' �ed Yes.❑ o (.., _ r Water Table Depth_- --------- A.- � Rotk�S' ----------------------------------------- Water y � -- • 4 z KFo`un�cl�ation_f' t Distance�to n: . ., . . --- S- me - ... ... � Barest: Well'._ � �. --•-- �- -- --- L �1 fr -------- te- REPAIR/ADDITION [Prev=Sanitatlon Permit#__'_ 77.� `--- - l`ts�e. ---- ------ ---- I ------------- ------------------------ 1 � - --- --_- --------------- ---------- -=------- ---- - ai i Septic Tank (Specify Req- uirements)-------------- ----- -- -- ----- '-------------••------�------------------ -------------�� -- Disposal Field (Specify Requirements--------- 3 _ -- --- - --------------------- ----- -------------- ---- { �: a , ._ r � -------- -- - -- ---- ---- ------------ - ! , - ---------------- ------------------------------- (Draw ------=------- ! - - (Draw exlstingand required additionon r_e,a�e side) I hereby certify that I have prepared`this application,and that the work will be. done in accordance with San Joaquin County Ordinances, State'Laws, and Rules and Regulations a of- the San .Joaquin Local Health District. Home owner or licensed agents signature certifies the following: [ " i the erforritan e'ofTth4 work for which this permit�is issued, I shall not employ any person in such manner,as I certify that p to became s ect to Wo s mpensa#iori aws of California." :Owner r ' Signed----- -------- ---------- ------ ----- ----_------- -- � # , r - - _ __. --------------- Tit1 "f c .—.. ' (If other than owner) FOR DEPARTMENT USE ONLY ` -- ---- ----- - ----------- - DATE. APPLICATION ACCEPTED BY_-_== -- -- - -- C � _ 1\ � ------ ----------- DATE ----.--- - -------- ---- --- ------------ DIVISION ------ --- DIVISION OF LAND,;; UMBER --- ----- -------- - -------------- -----=--- ----- -- ------------------------.- :. . ADDITIONAL.COMMENTS_-_-__. ,41 -. ._.__- . — --------------- ----------- --------- ., ------------------- ----------- ------------- - ------------ -- ---------------------- ------------ --- -- : . Final !ns ect ------- -- ------------------------------ --- •------------------- / Inspection-by �- "'"'""'"�="-'�--==---'--"--'=-�=---'------'--�-----� Date. ----��-�-� ---- ---- -------- p y- -- - ---- ------ ------- -- -- F&S 21677 REV. 7/76$M EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT