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' 4A kU/Z� Vie. -FOR OFFICE USE: FOR OFFICE USE: J s j APPLICATION FOR SANITATION PERMIT P { l ;-Q d=`� Permit No. 7- ------------- (Complete in Triplicate) p(•I(c pfit rtl C p ` 2 1 �, .. Date Issued__ ._"_-_._._ .�; t --------.-_-., This Permit Expires 1 Year From Date Issued Application is hereby made to'Ithe San Joaqu n:Local Health District for a permit to construct and install the work herein described. This application is made in compliance with C6unnty Ordinance Noy549 and 1existing-Rules and Regulations: _ t JOB ADDRESS/LOCATION 1.... G10ENSUS TRACT------------- �.-_ Phonel --------Owner's Name. dip_�. ----- C Address-- y � ' 0 . Contractor's Name------- .__. License -- -6-Ph ne Installation will serve: ResidencE Apartment House.❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other__ ---- -----' ------ -------- -- — Garbage Grinder_ .____ _-Lot Size ___ < _� Number of livin units..__ - _�1ulber�#,beclroors-«� g �w � Water Supply, Public,S stem and name_._ -._ � _ _ nv ❑ �. P a#e Character orssoil to a depth of 3 feet: Sand ❑ 'Silt❑ Clay ❑ Peau❑ Sandy Loam,❑ Clay Loam m � -- �- -' Hardpan ❑ Adobe ❑ i .Fill'Ma#erial.-.--`-.---_If y:es„type-----------------•--:-� (Plot plan, shov+�ing size of lot, location of systemin gelatin o"wells, bviicl,ings;`etc. must be placed on reverse side.) NEW INSTALLATION: (No ''septic tank or seepage�pi .permitted 11"public sewer is available within feet,) �c L�d Depth.---- ----�--� PACKAGE TREATMENT ,( ] f'SEPT;IC TANK [ ] tT,fi Size-------- -- - ----- - ------- p IQL� ��" Materia ,�c - Vo. Compartments---------- ----- f- f ------- f--1 ..`., Distance to nearest: Well.______.�� •----------------•-=Foundation_.___ ._ Prop. Line.__ - .I y LEACHING LINE [ ] No. of Lines--------- -------------.Length of a ch hna...--------- '�� -------Total Length.------------ 0- --------- 'D' Box-. -----Type Filter Material ---f� Filter Material.----------�- -------------- ' I Distance to nearest: Wel1_:�_��.- _r' -----Foundation.--- -J ---------- Line--------- --------- f Rock Filled EEYesPg No EJSPAGE PIT [ ] Depth/ _ `__Number_____ -------------------- �� t Water Table Depth---------------------------------------------------------Rock Size,---------A;---------- ------------------- - - f - ) Disfibnce to nearest: Well_.;___ ----=------,Foundation--- /e-- ----- Prop• Line_.-- REPAIR/ADDITION (Prev. Sanitation Permit#------------------- ----------------------------_Date-_._____-- ----------------=---------- -----) I Septic Tank (Specify Requirements)---- -----==-=--- - --------------------------------------------- ------------------- Disposal Field (Specify Requirements)___________________ __ - ----------------------------------------°--------------------------------------------'-- --------------------------------------------- ---------- ------------------------------------------------- ------------------------- (Draw existing and required addition on reverse side) / I hereby certify that I have prepd'red this.application and that the work. will be done in accordance with San Joaquin Count});, Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agent signature certifies the fallowing: "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 Compensation laws of California." Signed- ------------------------------------ ------------------ ------------------------------- , Owner � . g i .1 ----- - --- -_ t--- Title Y- ----- _ t if other than owner) t R'DEPAItTMEN SE ONLY APPLICATION ACCEPTED BY_t }.-- ---- ------------ DATE -�d�r- -- --------- - - DIVISION OF LAND NUMBER.----- -- --- -- ---- ----- - ---------- DATE------------------------------------ ----------- ADDITIONALCOMMENTS-------------------------------------------------------------- ------------------------ ----- ----------------------------------- - --------- -- =. -- - --------------------- .-------- /� f ------ ----------- ----------- ------ Ut4IN _ Date-_. Final Inspection by. IL(! .. R / EN 13 24 LOCAL HEALTH DISTRICT 1677EV.'7 76 3M