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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----- ------------ - (Cofmplete in Triplicate) , Permit -- L..7 Date _________________________________________________________ This Permit Expires 1 Year From Date lssueA ` 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: JOB ADDRESS/LOCATION--I31s747 S,. ------..77------------------------------------------CENSUS TRACT------------------------------- Owner's NamepL �4Z`---------------------------- ----------------------------------- ------------------------------------------------- Phone--------------------------- - Zi --------------- Address-- --- Z.7/JA--------if.• �'��Ae." -�.T•---------------- --- --------.City---r Contractor's LA+-C*_License #.-Tair i—i---..-Phone_4A-1!'"'`_3r.?_-xFJ.ao Installation will serve: Residence X Apartment House.❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other--------------------------- ------------------ I LA___.Garbage Grinder---_ ---_Lot Size-3.31 k_wd�7�A3s7td-v.__------ .._ Number of living units________ ______ _Number of bedrooms.___ Water Supply: Public System and name--------------------------------------------- -------------------------------------- ---------------------------- ----------------Private � Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe PN, Fill Material-------------If yes, type-------------------------------- (Plot plan, showing size of lot, location 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,] PACKAGE TREATMENT [ ] SEPTIC TANK bo Size-----tdre_Q---,9r__J4J<L i-Ar-----_--____Liquid Depth_.S"Af ------------ %4 Capacity--- Q-Q'-----Type----- -----------------Material-- ----- -----------------NoCompartments.------- -A- --------- ----- N JI Distance to nearest: Well--------1_¢0-�- ---------------Foundation-----Lam..__...._......Prop. Line.-----—- ------------ -- LEACHING LINE ) No. of Lines-----------4--------------- Length of each line.__._1?-----------------Total Length '__3_4k7----------------- -------- 'D' Box---- .--_TYPe Filter Material Q�-�__.Depth Filter Material---"4 ------- -- --------------------------------- Distance to nearest: Well-_--40.0!-------------Foundation.___.e2,7..-........_.....Property Line - -�-O__.__________._______.. SEEPAGE PIT [ ] Depth----------------Diameter--------------------Number---------_,--------------------- Rock Filled Yes ❑ No ❑ WaterTable Depth--------------------------- ---------- -------4- -- -----Rock Size------------I----------------------------------- Distance to nearest: Well------------_------ ------__-------—Foundation---------------- ----------Prop. Line--------------------------- REPAIR/AIDDITIION (Prev. Sanitation Permit#--------------------------------------------------Date----------------------------------------------) Septic Tank (Specify Requirements)--.__ 0. Lc.t/.____-.-___'---------------------------------------------------------------------- r� I Disposal Field (Specify Requirements). j-`Zpi- X_A4.7---„ V_j-------4__iA W__4_1An--------------------------------------------------------------- --------------------------- ----- (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done 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: "I certify th ' the performance of the work for which this permit is issued, I shall not employ any person in such manner as to beco sub' to Workmgns�mpensation laws of California.” Signed -----------------------Owner BY =------------------------------------------------------- -------- ----- - --- - -----Title.------------------- - - - - (If other than owner) FOR DEPARTMENT SE NLY APPLICATION ACCEPTED BY. '� c G -s °=-- -------------------- DATE -- "T DIVISION OF LAND NUMBER . DATE = ADDITIONAL COMMENTS------------------ -- --- ----------------------------------------------------------------------------------------------- --- ---- ------------------------------------ ti D----------------------------------- - --- Final Inspection b ------------- _ EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7/76 3M