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FOR OFFICE USE: `-IV tAPPLICATION FOR SANITA 1ZiollT JOR OFFICE USE:----- ---------------------- ------------------------ (Complete in Tripli . it No----------------------- Date --7 - /� --------- ---- - -- -------------- MAR 13 1978 - - - - - � Date Issued____3_1... � This Permit Expires 1 Year From t Is ( rhi � JJ t k)Ifi TRd U a Application is hereby made to the San Joaquin Local Health District for a per t an install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 1 JOB ADDRESS/LOCATION---- -`D� ----- . 27 ----- ------------------ CENSUS TRACT ` Owner's Name- -A.� q 2;P _.e& -,� ° = [ Address-___ J City -``J- --�iP = / �- - �.-�-c . -------- ---- ----- ` _ }� ----License #: -- ,."_,.� . '' � '`" ::.-- -- '�z"-�------Phone-----------------------------�----- + Contractor's Name__-__--- _ ._ �� Installation will serve: _ Residence E . Apartment House.❑ Commercial ❑ Trailer Court° t... t�Motel .Other-- Number of living' units;----------------Number of..bedrooms------------Garbage.Grinder----- -Lot Size :-____. ._-_._.------------------------------- Water { - - ------------------- -- Water Supply: Public System and name :- ----- ---=-------- ----------------------------------- ----- ----Private r❑ —Character-of-soil to a depth of 3 feet:-•Sand ❑ Silt❑ :Clay_[�. Peat_0_-Sandy Loam_ ❑ . ..Clay Loam ❑ -- f Hard „an . . . - • ,,. ,_ I p ❑ . Adobe ❑ 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.) f PACKAGE INSTALLATION- NT •[[No -p. tainV or' seepage pit permitted if public sewer is available within 200 feet,j s � K [.] . Size------- -------------------------- --- -----------------Liquid Depth-------------------------- Capacity------- -------------------------Capacity------. �-. ___:Typed--- ------ ---=----Material --,--No.` Compartments ---------------. -- ---------------Distance to nearest: WeIL._ "a _ Fondation Prop. Line n Lme-_.-___.__.____.___- -' LEACHING LINE [ ] No..of-Lines---------- of each line-------------------------------Total Length -------------------- - --------------- 'D' Box__:---------Type Filter Material'- Depth Filter Material --- ---------------y-.--------------------------------------- 4 Distance to nearest: Well-:---------------------a4t---Foundation--------------- ---- --"_--._Property Line----------------:------------- ---- SEEPAGE PIT [ ] Depth----------------- � '� -------------------- . Rock Filled Yes.❑ No ❑ .Water Table DeDthmeter:..____-*- .�____.yVu - - p ------ 'Rock Size----------- ------------------------ ------------`------- ---------- REPAIR/ DITEON (Prev.Distance to'rie6rest: Well, �'- Foundation. " Prop. Line --- -_ -._ ------- --- Sanitation Permit#_- a Date - - --------------- - eptic Tank (Specify Requirements) � = ---=--=----- ------ - - ----------------- ------------ -- y , 1 - ' Dis o I Field (specify Requirements) .. A�� },may- --�-__ �� ________________ ____________ P ] __ r i - [Drawxisting,and required addition on reverse',side) , I hereby certify that'l have prepared this'application and that'the work will be d'one`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 subject to Workman's Co ensation laws of- California.” f Sighed_r ------------------ ------ - :..' --_Owner c , y -- .. B I,f other than owner ...-Title--- 4 --'�' _�'---=--- ----- t E ( [ _"_. FOR DEPARTMENT USE ONLY` r APPLICATION ACCEPTED BY =------------->----------- --'=--- --•-------- --•----- ------------------------ DIVISION OF LAND NUMBERCA --_------'----- '----- = DATE. -------------------------------------------- .. _ ADDITIONALCOMMENTS---------- ----- -----------------------------------------------------------=--------------------=------------------------------------------------ ---- --------- .: -------- _ -- -------- - ------ -• -------- Final inspection - =--- - --JOA --- ..-.,R Date '"L- o'S-'� f EH 13 24 SAN QUIN LOCAL HEALTH DISTRICT F&s w. 7176 3M