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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT /` Permit No."-_77r-.7 1"- ------------------ - ------------------ ---------- ------ (Complete in Triplicate) ----------------- Date Issued.__91--, 7,2 -- _ This Permit Expires 1 Year From Date Issued �� y � � � ��^a Application 1s hereby made to the San Joaquin Local Health District for a' ermit to construct and in'stdfl'the-work,�he ein described. This application is made in compliance with County gqrdlnar}ce No. 549 and ex' ng Rule grid Rao or�: ` > 4 To girl rse d'��<tt'E �o/ •sirT y� /T � �( y -10 ` ! - JOB ADDRESS/LOC ION.'TD RY/.N/-_.; � .: .. - T I ere e------7V!SCC ' - - Phone '2" 17,---------- me. # _Owner's Name..-.. .. ieU - ' '. �7-$' '1qT (,( /f 7/ - / �' = 'City_.g, A7 . ------------------- -- Address ©7�Pp?e -`. -- - - - dip _5 �/ s - Contractor's Name----------- Ph n - -�•, Installation will serve: Residence (B: Apartment House ❑ Commercial ❑ Trailer Court ❑ { ' e Motel ❑ 'it'r' Number of living units:--._,L---------Number,of_bedrooms __F�._"Garbage Grinder._-.-..__.. Lot Size_. - ---------Pr-- ate ` -------------- iva �' Character of soil,to a depth of 3 feet: Sand ❑ Silt Cla = - *-.- -- _ ..---. a Water Supply: Public System and name-----"-___.-- -.-------`-------_---- -- ' � _ ❑ y ❑ Peat ❑ Sandy Loam, Clay Loam ❑ '" .. --: ----If yes,tYPe--- ------- ---'-------------- Hardpan ❑Adobe X Fill Material i /((Plot plan, showing size of lot.,1 cation of system in relation to wells, buiIdings,'etc, must be placed on reverse side.) ---�! it errri'ifited if public sewer is available within 200 feet,) . . . LNEW INSTALLATION: (No; septic tank=or seepage-pit p �/ p a ��....r 4... . $ie .1 __cl Liquid Dep#h_- r'�' .PACKAGE TREATMENT [�1.,,,,.SEPT•IC-TANK QQ f� -No. Compartments--.--_ -- Capacity 3016 0ype. -- --.Material.- � P Y------------- -' = ,rt w Distance to.nearest: Well'_-- -- ---- Foundation--- = _...Prop. Line } � r ft 1 __ � a - � of Lines'-- �- . Len of ea I"ina.-_ �. - ---.--- -.Total en�gth._ 1.- e LLEACHING LINE' No. ni .' Tf•� �� Depth Filter Material. -------..----. Box.- ✓�- -Type,Filter M erial.-- -- -- P . n r, . if �t _ oundation 1- =------=---.Property Lined Distance'fo nearest: Well. _C -_- _-- --- J j' .. _ r. . . . ,. . k Fill N _ - � Roc ed Yes.[] a� SEEPAGE PIT [ ] Depth------:_'t Diameter---------- ...`:----N.umber---------- '------=--- �. Size - s Water Table Depth{- - ----` ---------------------- ori - -- - --- ------------------------- ----Rock S e� --- .Pr p. - -- i ` Foundation o Line----- are t:_Wel Distance.to ne ADDITION [Prev. Sanitation Pe I -------- REPAIR/ f _ m1 #.. V = = -----, ate.---- 4� a ------------- --------------------- ---------- - ------------ ------------ } ,. Septic Tank (Specify Requirements): = = ' f -. Disposal Field (Specify Requirements)----------- -- -------- ----------- --------------------------------------------------------- I 1 w -------------------------- ---------------------------- ---- ------- ---------------------------- --------- - ------ -. - I -------- ----- --- - - ..-. ----- - ---- { ------------------------------------------ Draw existi r-=' -� - �• ""� ng and required addition on reverse side) .? ( licarion and that`the work will--be!done-iin-accordance with San Joaquin County 1 I hereby certify that I have prepared this app 4 Ordinances,, State Laws, and Rules-and Regulations ofthe Sari Joaquin Local FHealth District, Home owner or licensed agents signature certifies the following: r 1 "I certify th"at in ,the performance of the;work for which this permit is issued, I shall not employ any person in such m"anner as to .become subject Workman's. Compensation laws of]Cal fornia." _ i Signed ` _ -- -` ----- -- Y ---------- ----------- " I� {- { (If"other than owner) itf i 1y.. ' FOR DEPARTMEN�Irl ONLY APPLICATION ACCEPTED BY_. _ DATE - ; DATE. 17 :._� -�I - - ----- --- DIVISION OF LAND NUMBER ------=-------------- --------- -------.----:--;--- -- ------ 1 ADDITIONAL COMMENTS------------------------------------ -------.---- ---------- - --------------- ---- ---- ------- ---------- ---------- ------------------°--------- ---- -------------------------------- --- ------------------ :-- ----------- --------------------------------------- t ------- ----------- ------------------- -------- --=------ -------------------- ----------------------- -- -- -------------------------- ---- E ---------'------ -------------.-- ----------- - - !s` Date - ---- i --- Final Final Ins ection bY° -- ---------------------------------- -------- - r F&5 21677 REV. 7/76 U EH 13 24 SAN JOAQUIN LOCAL HEALTH TR T ,,