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FOR OFFICE USE: FOR OFFICE-USE: APPLICATION FOR SANITATION PERMIT ------------------------------- ` Permit No 29.-__6_A-5 ----"""------------ - (Complete in Triplicate} - ----------------- --- ----------------------------------- Date Issued?-��- - 7-� ...._-- ------------- --- This Permit Expires 1f`Year From Date Issued Application is hereby made to the San Joaquin Local Health Distr ci t for a permit to construct and install the work herein described. This application israde in compliance with County Ordinance No. 549 and existing Rules and Regulations: i JOB ADDRESS/LOCATION ' -------------------CENSUS TRACT--•--_ --------------------�--- � - -------- Owner's Name =-------- -- `_ '----------------------------------------------- - Phone----- "------------------------------- Ad --------------°✓_<. ? -- - - . ------------------------ Contractor's ---------Y--------- CitY2 - _ ZAP------------------------------ dress1 - - Contractor's Name---- . �y� `r s` License #_ Z_� _~._Phone------ ----------------------- -- Installation will serve: Residence ( Apartment House.❑ Commercial ❑ :Trailer Court. ❑ .. ._.. ,,_ . Motel ❑ Other------ -. _-- ------- - : .. �-------- ---- _ - g ��OX Z 10'� X, 2 3 Number of.l.ivin unrts:- �. _____Number of bed s..__„_._.__.Garbo a Gr inder.__________Lot Size__.__- Water Supply: Public System and name___; .iG ------` �s "__ _se ,- _--- '"yam' f ~---.--------____ Private ❑ Character of soil to adT epth of 3 feet:w Sand ❑+Silt❑,Clay ❑.�P_eat�_ Sandy Loam [Clay Loam E]Hardpan EJ 'adobe 0y--Fill Materia.L.._._.___.._Ifyes;'type__________________""____..___._% t 5 "-.{Plot plan, showing size of lot, location` f--system in relbt.1.0 to wells,'buildings, etc, must be placed on reverse side.) 1 NEW INSTALLATION:' (No septic tank-W--seep ge pit perrriitted if public sewer'is available within 200 feet,) ' PACKAGE TREATMENT” [ ] SEPTIC TANK ' Size__Y_ --._ ___s. _�t_`_ ='�:_ [. ! Liquid Depth._ -----`- --- -- -- ' pacity-_G_ _-____Type__ _ Material__ - _�_No:Compartments---------------------------------- Ca Distanceto nearest: Wel!-;,•---__;,-- b.C?_,- •-=--------------Foundation-i-----i�_0�u✓...M.•Prop. Line-.------.5-" ------ LEACHING ---_ a LEACHING LINE [ No. of Lines_._-..-__3___,_._.,_ .Length of each line-------- ___l.___L.____Total L yngth _____ __ _ ________ ----------- ;.'D' Box--._-�-----Type Filter Material----' ,7,- ----Depth Filfdr Material-- V- -------- -------✓--- -----------`---. Distance:to nearest: Well-_____.._b0__1___----_Foundation..__-_---f_ -----=___.Proper'ty Line----------------- ----'_._. ' SEEPAGE PIT [ ] De th---------- ----Diameter-=-----::-.---_'----Number------------------ -- p -------- 7 Rock F'filled; Yes ❑ No R Water Table'bepth__ __ -.Rock Size ` - . � `'-�_ ------ - Lne -r-------bistance-to nearest: Well `_____'____ -----------------------Foundation-_ .--._-.---.`_ ____.Prp- ---- REPAIR/ADDITION �} [Prev.'Sanitation Permit# -------------.---------- -- � :Date--------------------------------------------- Septic -------------------- --------'---------- Septic Tank (Specify'Requirements)------- --- ---- ---- -----------------------------" -- --------------------- ---- - Disposal Field (Specify-Requirements)----------------------- --------------------------------X------ ----- = r -----_--..__ certify that I have tired----.-- _ _ „----------_--------------------------------_ .---------------_-----------------------------------------------;-------------------------------- re a(Draw existing and required addition`on reverse side) , J I hereby prepared his application-and that.the work will be done in accordance with San Joaquin County Ordinances, State Lawsi and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents signature certifies the following: - i ,&J"I Certify that in the 'performance of the work for•-whiiFi"this�permif is issued, I shall n � n s?i u anner,as � to become subject to Workman's .Compensation: laws of California." � Signed- -----------------------_---- Own err U L+ 3 199 By------ -=------------- ----- --------------- Title--- - -- ---- --- . -- . - ----- ------ (If - - , cr, 1 other than owner} i # i SAN JOAQUIN LOCAL. FOR EPARTMENT USE ONLY' HaNTt APPLICATION ACCEPTED BY v'-.-- C. _ DATE._. T =------------------ DIVISION OF LAND NUMBER: --------- ---- -- ------------------------------ ------=----------DATE----------- ---- --- -- ADDITIONAL COMMENTS-----=---------------- -------------------------- - ------------------------------------------------------- 3 # -------------- ------ ; -- --- - -------------------------------:---------- Final Inspection by:,. « , .� - ter. T Date. -- ---- - ------------ -- ------- ----------------- ------ EH 13 24 f , SAN JOAQUIN LOCAL HEALTH DISTRICT �s s� REV. 7/76 3M•