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FOR OFFICE USE: FOR OFFICE USE: . ,r APPLICATION FOR SANITATION PERMIT _ ' Permit No....7 ------ ---------------- (Complete in Triplicate -------- - 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 andRegulations: .w ; TRA -- -----� CENSUS CT--------------------- { JOB ADDRESS/LOCATI N._, O `J� : } ----- , t Owner's Name..Q --- ----------`---- - one__ .- Ph �. 74- Address- ------- ------------- -------- Y h e._ /� Ct Contractor's Name.' -lam_ - ---- ---- ------- _-License #1c P e . . Installation will server esidence Apartment House.0 Commercial ❑ Trailer Court. El t # -}- Motel ❑ ' Other-- ---- ------------------=------------ Number of living units:- ._._---_Number of.bedrooms-_ ' eC -----------Lot Size----------- - + I ____._Garbage Grind ---Private � + t r soil-ta.c System and name------------------ ------`-----------.-- ------- ------= ---:-------_--------- Writer Supply. y: Publi -, ---- :- Character �. a dei pth of 3 feet: ; Sand El Silt El Clay El Peat L] Sandy Loam K _Clay Loam El :-Hardpari ❑ Adobe❑ Fill Material--------------If yes,type---------- ------ (Plot plan, sho\A ing#size'of lot, location of system in relation to.wells, buildings, etc. must be placed on reverse side.) 1 <4p y i NEW INSTALLATION: (No sepfic _tank-'°or seepage ,pit permitted if public sewer is available within 200 feet,} Size - c---------------------------- PACKAGE - y ---Liquid Depth- - ------- -- ------ TREATMENT ij ] r SEPTIC-TANK It] " t Capacity.. YTYPe "' Material = --No. Compartments--------- - ------- ------- vl Y r /�q ,. . 'Distance.to,nearest: Well - -----------.:Foundation- = Prop. Line I H1 jl Total Len th --- Q.1 --- Na. of L�nes____f- ----_- Length.of each line.---=- dam:_ ._-------- ,. g LEAC NG LINE [ ] , D, Box--=---------Type FfVl ' Filter aterial`------'------`-----Depth Filter Material-- --------------------------------------- ------------ ` } � to nearest: Well ;_-_ Foundation----_------------ DistanceProperty Line Ye N ❑ [ ] Depth- ----- ------------ ----Number--------------------------------- ------------- ? + led € Roc Filled s ❑ o t SEEPAGE PIT'--' ._�._ .... , . .. -Rock Size -- --------------------- ------ Water Table Depth--_'_ ____. .,.�-- w # •,,, • aF s - ----------- i Distance to nearest: Well-'-: Foundation------------------------_ Prop. Line._. j -- --- : .. - , � - -- --------_ ------Date = ] REPAIR/ADDITION (Prev. Sanitation Permit#--.-----"----------- ------------------------ Septic ------------------- -`Septic Tank (Specify:Requ-�rements)-- `` �'` ~' - ---- -------- ---------- Disposal Field (Specify Requirements]--�`."_ --=--------------- = ------------------------ -----=------=------ ----- - ------- ------ -- --------------- ------ ------. ---- 2 -- y --------------------________________ + _ ------ ------------------ . �- .. ------ ------------------ ---------------- ------ {Draw existing and required addition on reverse s;de] i I hereby certify that l have prepared this application and that the work will be done in accordante 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: 4 L I :i "1 certify that in the performance ofAe work for'Which this permit is issued, I shall not employ any person in such manner as to becomeAubject to. Workman's'kampensation laws of California." t ` r . _ Signed-- - -.vcaner !/ B t , :,� _ -. -- - -:.Title-.---:__ - t --- = T -- i i Lf other E 44 F DEPAR. ENT SI)3 QNLY APPLICATION ACCEPTED BY ___-----------DATE --------- 3 - -----,.-.,DATE.------- = DIVISION OF LAND NUMBER-------- ------------------------- --------- - ADDITIONAL COMMENTS-----` ------------------------------ ------- --- --------=-------- :. .. ------------------i---- i __________________ ___ _________________________________________________ ______________________.___ ' G ______________________q____.--------------------------- -------- _________'____________ ______________________________ __.------ __ _________________,____ = W. ._ ae.. ___._.__ ____________ � - ----- ------Y-------- -- Final Inspection by:.. ---------- ------ F&S 21677 REV. 7/76 5m t� EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT f