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FOR OFFICE USE: <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ------------- --------- --------------------------------- (Complete in Triplicate) Permit <br /> Z�_ 77 <br /> ------------------------ Date Issued- 3 <br /> This Permit Expires 1 Yea Frofn Date Issued <br /> (A <br /> Application is hereby made to the San Joaquin Local Health District for perm' t construct and install the work herein described. <br /> This application is made in compliance wrth County Ordinance No. 549 and existing Rules and Regulations: � y« <br /> JOB ADDRESS/LOCATION_- -�s�' �✓'� <br /> AQP- <br /> - '"- ��, ._ - CENSUS oT eA ---- � <br /> € __ -- ----- ---- - ------- - -- - -Ph - <br /> owner's Name..__--__"" <br /> i -.Zip- <br /> - <br /> Address.-- -- --------- --------- ---- --- - <br /> --------------- City r <br /> t License #_-�� - ----- one. <br /> Contractors Name - " <br /> 01 <br /> Installation will serve: Res idenceApartment.House.❑ Commercial E] Trailer Court ❑ A I <br /> r Motel F-1 Other <br /> Number of,living units:__'------ ___Number of bedrooms_'.,_--Garbage Grinder___.:•_:_, L Size_____ vat <br /> ` = - ri <br /> / P . e� . <br /> Water Supply: Public System and�narrie -", •---- ---- ---- ---- --- ---- <br /> Sandy <br /> "" -- - T <br /> I p .Silt <br /> Cla Peat Sand Loam [ Clay Loam ❑ <br /> Character of soil to a depth of 3 feet: . Sand ❑ ❑ Y �, .. ". <br /> NIardpan F-1Adobe ❑ Fill Ntaterial_-._.'____._If yes, type----- -------------- <br /> ________, j <br /> {Plot plop, showing size of lot, location of system in relation to wells, buildings, etc.'must be placed on reverse side.} <br /> � . .. <br /> NEW INSTALLATION:— 1;(No'.septic tank -or seepage pit permitted if p"ublic sewer is avall/able within 200 feet,} � <br /> _ �r.G ` a" tl 66th- _ --- -- <br /> C;TANK] Size_- _. _C _ y , <br /> PACrAGE-TREATMfNT "jam] SEPTI' '}�. /°r ! : - --- - <br /> Capacity-i � Type' --:-. ' Material _ ,�'� <br /> r. �"No. Coinpartments __- - <br /> --------------- Z�ouncl n - --- ---~ -Prop. Line's-} ..._ - <br /> . , � � Distance�to-near'�estWell_.._ <br /> Na,.of Lines._-__. --- Length of line _ --------��'otal--------------------------------------------- <br /> 'D <br /> Length.--- --------------------------- <br /> eachLEACHING LINE. [ ] - i <br /> + i'f��==Dep#h Filter.Materia '�---- --- --- --- ---- - -- T <br /> 'D' Box ,/ __---Type Filter Material x". P go-f <br /> Distance to nearest: Weil___ ---. ' on__�K---_ .---- /-" --Property Line <br /> Foundati , <br /> 1 , Rock Fll ed Yes❑ No <br /> l <br /> SEEPAGE PIT [a] Depth' 'Diamete -__ _Num1 e ------------.. <br /> ----- --- <br /> Water Table Depth: ,� ._- - ock S1ze-: 'j------------ <br /> -------------- <br /> I <br /> R <br /> ( } ---------------- <br /> ---------- <br /> � ---- ---- --- <br /> ; ' . � --- -- - oundat1 n ------- ..Prop. Llne- <br /> _Distarice to ndgrreest: Well--- --- ------------------ <br /> _w_.. <br /> ---- -- --- ---- <br /> ' ' `------Date.--- -- ---- ----1 <br /> REPAIR/A DITION'(Prev. SanitatiopP.ermit#......... ---- - <br /> Septic Tank (Specify Require ent5'1"__A.------------ - ----------------------------- <br /> I <br /> - --- - <br /> - ': _ <br /> ---- <br /> ! .. --------------------------- --------------- ---- <br /> Disp Field (Speci.fequirements� } . <br /> 4 __ ._ .__ ___ -_ -- <br /> II------ <br /> --------------------------- _-- _- _ __.----------------- <br /> --- <br /> __ __. __ + _- <br /> eve;-�. g q • on reverse side}...": <br /> - (Draw exlstin and required addltaonj <br /> �I' hereby certify that have prepared this applies&tion and 1hattion and the work }ill be done in accordance-w.ith San Joaquin County <br /> Ordinances, State Laws, and Rules and Req u a#ions of the S,an.id q.r, Local Health District. Home owner,or licensed agents <br /> signature certifies the following: <br /> r erson in such manner as <br /> "I certify that in the peiifaritiariie of the`work for which this pern+it is issued, l shall not employ any p 3 <br /> to become subject to -Workman's Compensation laws of California.". <br /> YAZ/ <br /> 4 _ <br /> teL - --- ........ <br /> g <br /> --- <br /> 5i d <br /> (I'f other than owner) ` "^ <br /> +� FOR DEPARTMENT-USE ONLY' <br /> DATE --------------------- <br /> APPLlCAT10N ACCEPTED BY------ ---- <br /> ------ --- <br /> ---- <br /> DIVISION OF LAND NUMBER:-- -----:---- -----: --------------- ------------------- ------------ -_DATE <br /> ADDITIONAL COMMENTS ------ --------- ----- ------------------------------ <br /> -------------------- _ <br /> --------------------------------------------------------------------------- <br /> f ,n _ __,____-- ________________ __ ------ - ____-__- .____________-_-___.__ F <br /> --------------------------- <br /> ----------- --------------------- - - Date j �l ------------- <br /> �. Final Inspection•b t -- <br /> p Y ----------------- -------------------- <br /> - F&5 21677 REV:7/76 3M <br /> E++ 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT <br />