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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No.._7 � YJ (Complete in Triplicate) - Date ________________________.__._.._.___.____.__._____.__._ This Permit Expires 1 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 apd exitin ules and Regulations: JOB ADDRESS/LOCATION.--------yy-��-� ----------- �/1 Q�/f ---A?D-- -- --- --CENSUS TRACT------ - ----------------------- I Owner's Name.......4:5 /�'A_JW_&F<44 -- ------- ---------------------- ---------- ------------ ---Phone------------------------ ---------. -- Address.......................... ------ �i1f-4 ' - --------CitY---------------------------------------------Zip------------------------------ Contractor's Name------4 ------------------------------------------------License"#_�.��`(��_._PFione-- Installation will serve: Residence [ Apartment House.❑ Commercial ❑ Trailer Court ❑ Number of living units:--- -----------Number of bedrooms.0_.___Garbage Grinder------------Lot Size------ _7--____: ._ _ .__ �_________I________________ Water Supply: Public System and name------------------------------------------------- ._--------------------------------------------------------------`----------Private Character o soil to a depth of 3 feet: Sand Silt Clay ' p ❑ ❑ y ❑ Peat ❑ Sandy Loam ❑ Clay Loam � € Hardpan ❑ : Adobe ❑ Fill Material------------If yes, type----------------- ______.________ l (Plot plan, showing size of lot, location of system in relation to wells, building, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if �ubli!ewer is available within 200 feet,) PACKAGE ThEATMENT [ ] . SEPTIC TANK [•] Size_ �Q- _Q1 r -_X_61L:-------------------Liquid Depth'.__ Ca pa ______T 1i'.�GA97_Materi I________!____-________t_No. Compartments_____c _____ p Y ----=------ YP Distance to nearest: Well_,-` _--____________________ _____Foundation 1___/�6l-__1__________Prop. Line]----- ...... ine]_ - LEACHING LINE [ ] No, of Lines------ ___ Length of each lirig. �.. ] ' Total Length. ., , ________ ---- _ -� D' Box--- -------Type Filter Material- _�feath File;Mateigfi"'.___�� ___ , ✓ ; Distance.to nearest: Well___ 1-------------Found.Abn-_� '_+____ ___Property Line-----__ __.____.________- SEEPAGE PIT [ ] Depth-----------------Diameter--------------------Number_____Et" 9 } �_ Rock Filled, Yes ❑ No ❑ { j Water Table'Dep De th- ------ ----------- - -------- -------- Distance to nearest: Well--------------------------------------- -- oAdL6tion7 '____ --___.Prop. Line =------------------ REPAIR/ADDITION (Prev. Sanitation Permit#-------------------------------___ :-------------Datel�� -----------------------_____--- } .. Septic Tank'(Specify Requirements} - ----- '- ---------------------- ;- i Disposal Field (Specify Requirements) ----------------------------------- ---- ---- = i -----=------------- ------ < _ _ ----------------- - ---------- ------------------- ------------------------- ___ _ __B__ .� --------------------- _ .;__ i _ _JDr-a-w_dxi'stirrg-arrd required acic�tfiion.on reverse side] �/ ��,. I hereby certify that I have prepared .this applic�i'�ir�n'anll that the work--will be done in accordance with Soni Joaquin County i Ordinances,[ State Laws, and Rules and Regulations�of the San Joaquin"Local,,Health DiLtrict, Home owner or licensed agents signature certifies the following:•-� .41 r "I certify th�t in the performahce of the wb-rk fo>Lwhic this_.permit•.isrissued;I shall not employ an'jperson in such manner as to 1 beedcome�ect t Workman's�tor�pensation laws of California." I Signed-' f .j Owner I ------------------- --- -- --- Title Z r BY-------- ----- _ -; - > - - i { (If iOther than(owner] s t ! FOR EPARTMENT USE ONLY¢ APPLIC;4fFON ACCEPZED B1'== , --=.= "DA DIVISION OF LAND NUMBER------------------------- DATE------------------------------- --------------------------- ------------------- ----------------- ADDITIONAL COMMENTS_-_ ` ` ' - ~ ------------------------------ ---------------------------------- ---- ------ -------`1-------------------------------• ----------- ---------------- -------------------------------------- ------ ------------------ ------------- -------------- --------------------- ------------------------------- --------------- Final Inspection b s --------------------------------Date_. '""'/- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7/76 3M