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FOR OFFICE USE: FOR OFFICE USE: - APPLICATION FOR SANITATION PERMIT ------------------•---•-------- - ---- 7 (Complete in Triplicate) Permit No._7 __ Date Issued_/l_Z_'_ - --------------=------ ----------------------------___.._ This Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOS ADDRESS/LOCATION ,..:- .. --------------V1/--/),7/A--------------- -- ---..CENSUS TRACT.----- -------- Owner's Name--- ----- Q1-14-4� f 14Al—)0---------- ---- -----------Phone----- --- -------- Address------------ --- ----- 1.---------=------; r ... City- -------------------Zip----------c ------------------- Contractor's Name "W_._ :�: —� ___License # _ J_ _Phoney__ � - = Installation will serve: Residence Apartment House ❑ Commercial ❑ Trail`er Cdr ❑ • . .__ Number of livin units:-____ Number of bedroo Other______________________________ms� �"��`.�." } � �- 9 ..__Garbage Grinder Lot Saze._,._.../-- --- ------ ` ---------------------------- � f Water Supply: Public System and name-------------- --------------- -------- --:---------:.:------- -- ----------------- =. Private t Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ . Peat❑ Sandy Loom Loam 0 € Hardpan Adobe E] Fill Material------------if yes, typej------------ _ __ (Plot plan, showing size of lot, location of system in relation to wells, buildings, e c must be placed on reverse side.) NEW INSTALLATION: (No septic tank orlseepage pit permitted if public sewkr is available within 200 feet,] ' PACKAGE TREATMENT 5 '�; I /p y W [ ] SEPTI//C TANK [ ] ( Sized� _________Liquid Depth.___� ____ x '1 ti1Capacity_L_4:�" ` Typer=� � �-��l�Aaterial_---_�- - ---- I)lo'Compartments--.- { _ - I r ! -------- Distarice to nearest:.Well �_C5- _+�► _-t k.__Foundation /___C5__ V____._.Prop. Line__ gip_____ 6 Tr_ ( r� ., IV 'I I i � I LEACHING LINE; [ ] No. of Lines_ �_^:........Length of each'line _ ,___ > ' [ D' Box I".""_".Type Filter Material- Depth Filter Material_!_--]---------------_------_ _________________________________ - Distance to nearest: WeIL__c5_ Foundation_, _____________ .Property Line. ._�� ---__----_.___.__- [ ] De th-,__,___._`__._Diameter.____.__ Rock Filled Yes ' L------- - - - --- ----- No SEEPAGE PIT Water� l / ❑ ❑� p� �--------- TableDepth--------------------------------------------------- ----Rock Size-- ------------------------------- ---- r } _ Distance to newest: Well = -Foundation ------------------------Prop. Line.--------------- -._ r , I REPAIR/ADDITION (Prev. Sanitation Permit#__l__._.._.._____________.______._�---------Date.-----_..__________-----------;__, f v _ f Septic Tank (Specify Requirements) . __ ----------------------------------------- fes- == Disposal Field (Specify Requirements)------------- ___ _ ' _ _ ff 1 ,. - ---- ------`--------- ----- ---------- ----- -.-_ --------•---- --------------------------------------------------- I #---------- raw existing and required addition on reverse side) I hereby certify that I have repared this application fand that the work-Twill be. done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations off-the San Joaquin Local Health_District. Home_ owner.or licensed agents signature certifies the following: i f [ ter..i�-i � �� ;. � • "I certify that in the performance of the work for which this permit is iss.uedr..` e , I shall not mploy any person in such manner as I. f�-t . . p .: ( t to Become 4b'ect oeIkman's Com ensation laws of California."' )- Signed- t '' ��/ y { � Ownc�rf B Y--------' k- -f- '.Title (!f other than owner) r i FOR DEPARTMENT USE ONLY !J , APPLICATION ACCEPTED BY. ---'-------------------- ----- ------------------------DATE.-- 7--7. DIVISION OF LAND NUMBER --=--------------- ----- ----------------------DATE ------------- `" ADDI7IQNALCOMMENTS--� -------------------------------------'---------- ---------------------=----- ---- ---------------------------- ---------- --------------------- ----------------- ----------------=--- --- - t ------' � --- --- ----------------- ------- --------------------------------=------ ------------ -------- ------=^ --------------------------------------- ?--------------------- Final Inspection by:-..- ----- `� _ ------------------"=-----------------------------Date------/ie-- 274" ' ---------- EK 13 -- e" '3 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 eFV._j/76 3M