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FOR OFFICE USE: d OR OFFICE USE: APPLICATION FOR.SANITATION PERMIT ............... - r7 9- s ZIV (Complete in.Triplicate) Permit No............. .... :.......... ............... Date lssued._It..��_.��..'_79 .........................................:............... 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'complionce- with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ---•q��a... a`'�'`�'��4a%.- a` . ----- PG � CENSUS TRACT........... k. Owner's Name... . .�.Y --- r ........ . _Q 7 ----- -- .............. ` . .Phone.- 6 -L3. .1. ..... [ Address_:I L 7. r a r�.�oS a� �Qd.-_....--- ---- ,-- -------------- City � ��"'- - Zip.-9 Contractor's Name Lt114_ /f .. License #---- ........=Phone. % ....__. Installation will serve: Residence gj-�Apartment House ❑ Commercial ❑ Trailer. Court,D ";— i, p ' Motel ❑ Other- ---------- �t... ...--"------.-41P jNumber of living units:-..,....:_.....Number of bedrooms. ..Gdrbage Grinder._ka. _Lot SizeTVA'--0V�i----�--=GC��s = r N • Water Supply: Public System and name-.-..W f .-_.___--:-.,_:_._.Private �1 r_...---.... . -.,....._,.. ---------•--•---------------- . .._ . Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ .. Sandy Loam ❑ Clay Loam ❑ Y� Hardpan ❑ I Adobe, Fill Material....... _._lf yes, type............................ ,r (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 ailable within 200 feet,) [ y PACKAGE TREATMENT [ ] SEPTIC-TANK [ ] Si e..._,� 0® _-•---- ----- 00 - -------------Liquid Depth.-' r /�' '.... Capacity./Oc.O0------Type*.- - --. ..Material QQlrteX . _ o. Co�partments---- y---- -- i Distance to nIV earest: Well_:..:,_.... ..._. .-.._ ._.....FouAdation,_._�Q_._._. y°Prop. Line_.. /�//�/ ............. LEACHING LINE [ ] No. of Lines . - .,-----.-..:_.__. ..Len Length of each I'ne �_. Length � � - 9 ` f�,- ��- . Total Len th -.... p---- - -----^------� 'D' Box-- Type Filter Material iQ0/J �eph�FTlter Material..-.- 1_--------------------- '--- _ S DistancetoDearest: Well----px,5�`.� Foundation.---` ------- Rock ;/`3�':..._.; ------_._. rte... - u . SEEPAGE W [ 3 Depth..f.�. ....Diameterol-.X - --Number-.--/-----.- Rock Filled Yes ❑ No Water Tablet , rt '! Depth.---•-----�0..�-. ----- ....._ -------- Rock Size_/- �...`.."..Z !�/�Q�-��r•/� Distance'to nearest: Well.---..49-J------------------------------Foundation_..IO....f .- ...-..Prop. Line.._ �...------. REPAIR/ADDITION (Prev, Sanitation Permit#------------------- -- -.- '}..........Date...............----------------- -- ------- Septic Tank (Specify Requirements[....: . = F _---_-- ----------- -------- ----------- -- Disposal Field {Specify Requirements).... --- -..GZ..--�p •[.ct- .c� .---Gam"--- = ------------------------------------------------•---•---- ------------------------------------ -------------- --------------- ------------ ---------------- ------------ ---------------------- - - ------- - ----------- I -•- -- Y (Draw existing and required addition on reverse side) I hereby certify that Chave 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 i signature certifies the following: �w r "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 su f c to Wor man' ompens tion laws of California." Signedx - -.... OWn "+ BY - ------------------------------------------------------------•-- ....... Title -- ...---•------- ------ ........ ----------- ---------------- (If other than owner) FOR DEPARTMENT USE ONLY DATE_.. _.Z G 4 APPLICATION ACCEPTED BY-------- -.... - •-------------- - ------------ ---------- -------- �� DIVISION OF LAND NUMBER--------....--� - -------------------- --- ---DATE.-----------------------•--- . -- .....-- ,ADDITIONAL COMMENTS-------------------- --------- .--•----------------------- --.......-_....------.------ --...- I ------------------------------------------------- Date •- ------- ----------• ..__.- -- _ ---------------- -------------------- - p ...- --- - / _ G Final lnspectron b .. . e" jf ---------- Date._.. - 2 �... y ( y ------ 4 v ` I AQUIN LOCM HEA F&S 21677 REV. 7/76 W EN 13 24