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FOR�FFICE USE. v FOR OFFICE USE: ^* ,_ APPLICATION FOR SANITATION PERMIT ----------------- -, � (Complete in Triplicate) Permit No.7.91_ - ---------------------------- -�---------------------- {E - Date Issued.-ff'.r.,.TX-' _______________ - ----- ---------.--.-------------. This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit o construct and install the work herein described. This application is made in,,cmpliance with ounty Ordinance No. 549.and existirig`Rules and Regulations: JOS ADDRESS/LOCATION J37� - - -1 -- --------- -- ` r s CENSUS TRACT ------ - Owner's Name--------- ` s 6� Address - ' Z ? - --------------------------- City Zip Contractor's Name-- - ---- j .... 41 4License # q'°'�s4 3if} Phone-. T_ 2 ------------ ------ g6d7.-.-. Installation.will serve: Residencerot Apartment House Q Commercial ❑ Trailer Court ❑ - ...»., wel ❑ s Other-- ; e Number of living units:__-_ 1_____ `umber o'fbedroom`s Garbage Grinder_-. --___._Loti Size_.-- . �..--.---- " r i -.``?- _ `•: Private, Water Supply_ Public System and name* - s_ ----- - ------ ^--- :---- Character of soil to a depth of 3 feet: Sand [�]�` Silt Qday OPeat❑ Sandy Loam ❑�-Clay_Loam ❑ HardpT Adobe tiEil! atenal_" -I#yes;tYPe = i __ w��Mfr r (Plot plan, showing size of lot, location of,system in elbt�on-to_w.ells,.buil.dings,.etc:-rrmust'be-placed.:on eve-rse side.) 'r NEW INSTALLATION:— `(No septic tbnk `or`seepage `f permitted if public sewer is available within 200 feet,] :4 �- . PACKAGE TREATMENT [ ] SEPTIGTANK [`] i Size's-= --------------- --------------------- iquid Depth-------------- JJ - , Gapaclty -- ---- Type�� tenial _---.:. `,-_ No:Compartments. P r #-. Distance to nearest:.Well.... a -----Foundation.Foundation. __.- _-_- ..--.Prop. Line-- ------------- I ------ LINE [.;] No. of Lines F_ Length of a4l in - -- -- Totai Length -- C_ LEACHING _ � Material - "-- - -- D' Sox---�------Typ_e Filter.Matenal J------------;•- - Depth Filter Ma l- --- ----------- � --- -- -t ----- --{ -(1 Pro er' Line Distance to nearest: ell, Founda ion P tY "' S � t = Rock Filled Yes E) No El SEEPAGE PIT [ ] _�; Depth- Diameter t - _. ..Number ' -Water TableDept ,'_ - ----------- - -� - ----•- •------ - - ------ ------ -. ock-Si� a-- Distance.to nearest: Well'-1 -- ----- ----- ` Foundation-. = Prop. Line REPAIR/ADDITION (Prev. Sanitation Perm -------------------- --------------- .--1 { Septic Tank (Specify.Requirements)-----';= _ = -..... - = ----------- -------- --- ------------ ----------- --------- - ------ - 1 Dis` osal Field (Specify Requirements): _ [wy'i Q - ---- t -------------- ----------- -------------------------------- ----- ------ -- -- ----- ^ --------------4 -- -_--_-- ��_ - -----------------.----- ---_- ----------------------- ----- -------- ---i' _ _---- - ...----- .-'.-- A - _- Com_ {Draw existing and required addition on`a er side)�J x c- r I hereby certify that I have prepared this application and that the work will be done-in-accordance with San Joaquin County v' 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 that in the performance of.the'.work for which this permit is issued, I shall notemploy'any person�in*such:manner as to become subject to Workman's Compensation, laws of California." ` j r 7;4 g _ A jr B - - • a BY-- -- r --- T� ifle� '(It other than owner) - 4 FOR DEPARTMENT USE;OkNLY APPLICATION ACCEPTED BY-'-- '. DATE =- ------ - ---- f DIVISION OF LAND NUMBER I DATE.-.--. -; _. - ADDITIONALCOMMENTS----- ----------------- ----------------- €----------------`- --------------------------- ----------------------------------------"-----'---------- . --------- ------------------ --- ---- - - : , ti Final Ins ection.b _ r�`"4 -Date-..----- ------ - A JOA URAL HEALTH DISTRICT Fos 21677 Rev. 7/76 3MEH 13 24 S Q