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F ! FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit (Complete in Triplicate) -- ------------•-•---•---------------- g Date Issued-y.,.11,7. -- ......................................................... This Permit Expires 1 Year From Date Issued :k Application is hereby made to-the San Joaquin Local Health District for a permit to construct an Stallibe work herein desc ibed. This application is made in compliance with County Ordinance No. 549 and existing Ru :ar RegulationsJO8 ADDRESS/LOCATION-- lNr � -5 � Lr/ 1' ,P� ------- - - - a �Q CENSUS TRACT----------------------- ...- iM ------------- Owners Name.-.. 4I�.-�--�:J-"------- -- ---- ��'G�-- -�----......--- - ....------ --------------------------------------- - --------------••- ...--- ---------- A . � _?C/4� Cit F ... f Zi Address. ,�!? l�._i.1'�'t+Y .� �-�----------------- ---:-.... .- _ y.`��'�'- - - . p--�%-��- -. Contrac#or's Name...Vert Y7Pf License #-. 9A?7.....Phone- 93.1..:,.�.e3g.... i Installation will serve; Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court � Motel ❑ Other--------- . ---- ------------------------ . Number of living units: r----• Number of bedrooms............Garbage Grinder.-,0Q*.Lot Size............... .................•-- _---.- -- --- il! Water Supply: Public System and name___------------------------------ Private Character of soil to a depth of 3 feet.' Sand-E] Silt tD Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam 210, : Hardpan ❑ Adobe❑ Fill Material.. ___ ....If yes, type-------------------------------- (Plot plan, showing size of lot, locat�an 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 available within 200 feet,] i or PACKAGE TREATMENT [ ] SEPTIC TANK [v4 Size..... ----------- ........_..-----Liquid Depth.-..:------------------ -� Capacity.../.,�d------Type----_.-....-..- .- ..Material-.�O> t F/4 -No. Compartments------- l Distance to nearest: Well__..J! �.----.-- ------------------Foundati�-.----40..... -- -- Prop. Line_... -.------=------- ( LEACHING LINE No. of Lines__.....-Z...............Length of each line-------- --_--------Total Length '--- -- `< D' Box...f..=�..Type Filter MateriaL.Rw-145; ..Depth Filter Ma`erial....---I-- ......------ --------------- - ------ f . . / Distance to nearest: Well---115V _-........Foundation----/4----------- ----Property Line..--.�------------------- SEEPAGE PIT [gig Depth.,�l.—I.-!."e:..Diameter..-� ------ Number -7 Rock Filled Yes P-' No 11 �.- I r � -1 �r r Water Table Depth-----1 0-a----------- - - --------------- ---------Rock Size. / o .74... All V Distance to nearest: Well--.-.-/��-------------------------Foundation....../ --..-- ----..Prop. Line.. ------ ----- REPAIR/ADDITION (Prev. Sanitation Permit#...................... ----------Date........:-------------- -- ---- -------------- t F Siiptic Tank (Specify Requirements(..,- . ----------------------------------------------- ----------- ........---........ Disposal Field (Specify Requirements) --- '---••- �� .. --- ----- ---- ------ ------- --- - ------------------ -------------------------------- - ------------ ------------- ----- ............ ------ Draw existing and required addition on reverse side] 1,1hereby certify that I have prepared 'this application and that the work will be clone 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: t` " "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 Compensation laws of California." Signed......it --------------- -•-----------...- --------Owner 3Title.- i f - ---- (if other than owner[ F "FO EPART ENT USE ON Y " APPLICATION ACCEPTED BY ->� _ ..- -- ----- -----------------------DATE . �� ....... DIVISION OF LAND NMB ...:. . .. .................. UER ........DATE.. ---- -- -- ---- ----------- ... ADDITIONAL COMMENTS.............. _11_._D �� . _... •---------- i� -- -........... .. ---------" -------•------..----..------...------------------------------.--------:- --------...----------- --------- - ..------. i --.. M -----------:-------- ----------- ---- -------------•---• --------------------------------------------------------- •- ---------.---1- ----- -------- -- - -------- . . ._ ---..Date.......... ." .-- . Final Inspdt ion by:...._ . ...... -'- -------.-_---_-_-------------- EF35 21677 REV. 7/76 3m H 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT EI