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FOR OFFICE USE: )/ FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------------------------- (Complete in Triplicate) Permit ); ;F*O.-j'dp. r 4100++c-of Date ---------------------..-----.----- - ------------------ 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: JOB ADDRESS/LOCATION ,-----..4,r.........no A?--------------- ----- ----------------.CENSUS TRACT.------- ------------------------ Owner's ---------------. . .Owner's Name /'? D- `-- -- ---------------- ----------------------- ----- ----- ----------- --------- -----------------------------Phone-------------------------------------- Address----- -------------- -------------Phone--------------------- Address----- - -------- --- ---------- --- ----------------------------------------------------------------- ----City------- --------- - --- ---------------------Zip-- ----- ---- --- Contractor's Name. }/lt_ l r!�d!1 ' " !..._�ul�Lr?li!f ".� / �"�e-License Phoney4%_-1f_'J!!�&/ ' Installation will serve: Residence LX Apartment House.❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other---------------------------------------------- Number of living units:------- ..._---Number of bedrooms_...3-----Garbage Grinder------------Lot Size III.? j?04 A.ii_fX_fl2WY _3-fl�� Water Supply: Public System and name--- -----.-Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe &j 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.) NEW INSTALLATION: No septic tank or seepage pit permitted if public sewer is available within 200 feet,) V a Af PACKAGE TREATMENT ( ] SEPTIC TANK [ Size----f.2_Q.d0....-- ---------Liquid Depth..---S'4-------------- Capacity..../-2-01-0-TYPe----------------------- Material--------------------------No. Compartments -----------01 Distance to nearest: Well----------- t .-------------------Foundation----------/.40- -___--Prop. Line.-.. -------------- LEACHING LINE No. of Lines._.____,_. , ,------..---,Length of each line------------� _.A.___.__--.Total Length._.-.1-7l__ _____________.--- 'D' Box. -Type Filter Material----- Filter Material-..... I./.. ................_-------------------------. Distance to nearest: Well.... .Q-Q....___.--.Foundation.--.-.--Z..?_e-----------Property Line....x`.40'..'o----------------_. SEEPAGE PIT [ ] Depth----------------Diameter--------------------Number-------------------------------- Rock Filled Yes ❑ No ❑ Water Table Depth-------- - ------------- Rock Size..-- ------------------------------------------- Distance to nearest: Well-------------------------------------------Foundation-------------------------.Prop. Line--------------------------_. REPAIR/ADDITION (Prev. Sanitation Permit#---------------------------------------------------Date-------------------_--------------------------) Septic Tank (Specify Requirements)---I-A-Q'4---..-- tAl.-e-'-W--a------------------------------------------------------ - - ------------------------------------------- Disposal Field (specify Requirements)--- '" !¢ . " X -- C -4d. i ' --------------------------------------------- ---------- ---------------------------------------------------------- ---------------------- (Draw existing and required addition on reverse side) 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/uUj to Workman's,,.Campensation laws of California." Signed----- - ----- --- _ _ Owner H »�---------------------- By--------- --- --------....Title----------- (If other than owner) FORDEPARTMENT USE ONLY APPLICATION ACCEPTED BY- �' - w'------- -----------------------------------DATE -- �f' = DIVISION OF LAND NUMBER. ------------------------------------------- DATE. .:_ ADDITIONALCOMMENTS------------ ---------------------------------------------------------------------- ------------------------------------------------------- ------------------------ ------------------------------------- -- -- - --- -------------------------------------------- --- ----------- --- ----- _ ----- -� Final Inspection by:---- - �/ --- -`tel'------------------------ ----------- ` ��-i------ ----- EH ---Date------ �� '/ � <5 EH 13 24 SA JOAQUIN LOCAL HEALTH DISTRICT Fos?y677 REV. 7/76 3M