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. FOR OFFICE USE: FOR OFFICE USE: ro: APPLICATION FOR SANITATION PERMIT ----------------------- Permit No. �7--;3 3 6 (Complete in Triplicate) --- ----- ---------- -- ---------- Date Issue ---- —i S--,7;7 ----------- 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 and existing Rules and Regulations: I SS/LOCATION-----`--- .7-- .�� ---- -- ._CENSUS TRACT -------------------------'•--- - Own erDsDName. // _ / /"ti /�2 -- I-------- --------------------------- - V71 . ' ./ d.g . . �! �1 Phone f� Address------ ------------------ ---- v� � _ � �E'a.-----------City Zip------------------------------ ^f�f9�l , � ¢- -.e[,5'--.�1�_License #. Contractor's Name-- ----:--`------`------=- - - -24Y3----------Phone--- ----- •` �- --°---- b �. Installation will serve: Residence Apartment House 7] Commercial ❑ Trailer Court ❑ i ( r. t Motel ❑ Other------------------- --------------•---.------ - Number of living.units:--__ ____Number.of bedrooms__ ___._-_Garbage Grinder-------___-Lot Size- W.- -a----. Water Supply: Public System rand nae i `_ - = -- '' Private - .Character of soil-t d dept_odf 3aneet: ]A n d❑ :Silt Ela lay 1-1 - ._Pelft ❑ Sand)-LFo6m+;❑* Clay Loam �.r,. 1 p ❑ yes, type- ! ` (Plot plan, showing size of lot, location of system in relation to wells, buildings,.e`tc. 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 Size__ __ _ ------------- ----------------------Liquid Depth. _._______________ Capacity--1 �� Type ' - `Material------------------- --- -No. Compartments-------'2----------------------� Foundation.__-_/ ------------ Pro Line__-- © -/_----. Distance to nearest; Well--- ._.________�_ -------- p• rr�. LEACHING_LINE V< No. of Lines._.__,.,--0________________Length of each line- --, ---------- Total Ll gth_,-.._ _ �__-- 'D' Box__:__1____Type Filter Material -- Depth Filter Ma�erial.____r. _______._______----------------- ------------ �J t �j Distance to nearest: Well_.__I_�_____________Foundation__ ___---______---Property Line._--------------.------ SEEPAGE PIT Depth.d�..Sf_Diameter_.33_e- -Number-----Z---------------------- Rock Filled Yes;;' No ❑ { "Water Table tbepth------�d Q-- ---------------------------------- Rock Size- �-= ;Distarice to nearest: Well- _ _ -.`--_--- Foundation____.I_�_'..____ Prop. Line_.�^�_ ( y ^` (//� REPAIR/ADDITION {Prev.iSanitation Permit#____:------''--•__"-------------------------------Date • `"' b ^! „ ------------------------------------ `'-------------- Septic Tank {Specify Requirements]--{°=6-----------------.:._ --------------- ------------ ------------------------------------------------------------ -------------------- I Disposal Field (Specify Requirements] {`_ _ - - i µ { `--------- ---------- -------------------------------------- =---- --------------- --------. - F --- ---------------------- r � ------------ ---------- 9- --- --required addition-- ---------- -.:---�----_-_----- = ----------------- aw ani I hereby certify that'll.have prepared this rappl elation and r' � tion an reverse -side]' that.the work will•be-done-in-accordance with San Joaquin County i 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 fhe performance of the work for which�Lthis•permifris issued, I shall not employ any person in such manner as to become'subject t Workman's C pensati laws-hof"California:."��"' ` �.LJte�� ..--- ------�b� Signed ��-tea-- ------- --- ��`' ---- --------- -- - f ------------- . d , r ---- ------ itle (If other than owner} f r. FOR DEPARTMENT-USE ONLY --DATE. ��. APPLICATION ACCEPTED BY----- l ='� -----------=----------- -------------------------: 7 --- DIVISION'OF. LAND NUMBER.------- --- - - - DATE---------- ----- ------------------- -- =--- a 'ADDITIONAL COMMENTS- ------- ------------------------------ ----- -------------------- ---------------- e - ----------------- ---------------------------------- -------- ' - - ---- ! r __ ----------------------- 4 ___________ _ _____________----- --------------------------------_--__________________-_-_ _ .___. _._ _ -__ Final Inspection,b t ------ Y.---f-------------- _ - ---- ----- ----------------'------------- Date /- EH 13 24 / ��?�' f F&5 21 67/76 3M i'/ SAN JOAQUIN LOCAL HEALTH DISTRICT r _