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/ FOR OFFICE USE: FOR OFFICE USE: /� APPLICATION FOR SANITATION PERMIT Permit --.---•-••----- ---------- {Complete in Triplicate} ------------ •...... Date Issued./� /�-�`6 _ ....--.... This Permit Expires 1 Year From Date Issued Health Dist for a permit to construct and.install the work.herein described. Application is hereby made to the San Joaquin Local This application is made in.compliance with.County Ordinance No. 549 and existing Rules and Regulations: , CENSUS TRAO-----.:... ...... ........ JOB ADDRESS/LOCATION Owner's Name. _L/..,. HCl.... �Y-- ------ ---------------- ........Phone: -- •--- -••- Address...._ _,.. . �f = . -- - (.�!-r- ,p ` --.... City... Zip.`:....... - / ----- - - } :..... Phone.-_1/ License Contractor's Name.'..+ -�_- will serve: LL Residerice Apartment House ❑ Commercial ❑ Trailer Court ❑ Installation otel ❑ Other---- - ---- - ----- ---•--....---•-- - -- r , 1.x_ ... , ......._. Number of living units;.....----------Number of bedrooms::-.- Garbage Grinder--------._Lot Size...,,. ..... --- •--Privet Water Supply: Public System and name'. .......... ....................... - e Character of soil to a depth of 3 feet: Sand [D Silt El Clay El Peat ❑ Sandy Loam ( Clay Loam El 'Hardpan (�� Adobe Fill Material.. If al.. .._" .... yes, type--- •----• vl .-----._ . (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 'I NEW INSTALLATION: - (No septic tank or seepage p ,) it permitted if public ewer is available within 200 feet PACKAGE TREATMENTCSEPTIC�TAMC . . Size..M�te�rial .../-- 2 ----------------- -Liquid Depth-•.- .--------------------: -- a acit tNo. Com arfinents.----- � 'Distance to nearest: Well /- ` Foundation......_ ... .. ...Prop. Line..... Len th of each line...... ----------Total Length ...�-- ' -�.{�. ...... ....... .... --- LEACHING LINE [ ] No. of Lines .- .. .-- g s -- --- --- ------ 'D' {( F Box. }' Filter Material-.. �� P th Filter Material Property Line.. Distance,to nearest: Well----- Faundation SEEPAG_ PIT pepth. J �..... ...Numberr -•---•--------•- ---- Rock Filled Ye�� No � Water Table Depth---------------------- ------.........Rock Size.---- ••----------- i - ------ ---.Foundation-- -- ---- -------- -- - - Prop. Line.... .------ ....... Distance to nearest: Well ----------- -- tl Date_... —...._----- ` REPAIR/ADDITION (Prev. Sanitation Permit#-------- --=-- ------ I dl x �. . . .�.�, ....: - . -- -----:•-- -----... ------- ... ... Septic Tank ( if Re lrrr --------- � ---------- Disposal Field (Specify Requirementsf.� � '�= .::,_ . ... ............... ......-.. ------: ---.. ---- --- - -....... --- ---- ------- -- --- ------ --- •---------- - --------- - • - (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin Cot rdinances, State Laws, and Rules and Regulations. of the San Joaguin.-Local Health District• Home owner or licensed agents signature certifies the following: 5 } "1 cert' that in the erFarmance`of'the work for 'ch this permit is issued, l shall not emptoy any person in such manner as to become subject to Workman's Compen iott laws of California."' Signed.. ...._.O er ' _. ..... .. i J - ....................4DAT ...... B (If-o her,,f an o ner) OR EPA NT US NLY J- -.,57APPLICATION ACCEPTED BY-......... ----------- ----- - ..... ..... ........... .... ---------------- DIVISION OF LAND NUMBER.--.--------- .--..... ADDITIONAL COMMENTS. ....................... ..... --------- ------- - ---- -------- :. - - ..... I.......... ... ...... ------ . rr . --. ...---. •-----•------------------------ -- --•----- -- ........ 4 -----•---- -----•----- --•- . --- :, �. ... - �..� . .m r J ------------------------•---- .: i ,.,, � ,. ----pate-. Final-Inspection b F&5 21677 REV.7/76 3M EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT