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A FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------- --------------------------- --- Permit � - . � (Complete in Triplicate) --------------- Date issued__/c;7-�a-4_ --------------------------------------------------------- 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: JOB ADDRESS/LOCATION------ - ---- -1��-�.-� 7 kf5 CENSUS TRACT Owner's Name lc'""i.L k ..----"------------------------------------------------- ----------------- -- Phone. l_1 = --------------- Address-------- ---------bAddress.------- -- -----�------ ----------- ---- -- -------------------------- --------CitY-7T44le4 - Zip----------------- - Contractor's Name.---,1'90 ------------- -----License #------------.- � -Phone------------- Installation will serve: Residence [' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other------- f------------ -- - --- ------ -I. rT Number of living units:___(__.-_-_.__Number of bedrooms----3---Garbage Grinder------------Lot Size---___.3_!:;-=-- ------------------------------------- - -----------Private Water ----- -----------_--.-:-.--.Water Supply: Public System and name 43- ---------------- '� - Private Character of soil to a depth of 3 feet: Sand;❑ 5� Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam = Hardpan ❑ Adn�e.0, Fill Materia L..--.--..--If yes, type-.-__ __---.---'- (Plot plan, showing size of lot, location of system in"relation to wells, buildings, etc. must be placed on reve4ei"§iCl'e.) NEW INSTALLATION: (No septic tank or seepage_pit permitted if public sewer is available within 200 feet,] �� f! (AI PACKAGE TREATMENT [ ] SEPTIC TANK [ ] -, Size______--- _ -_X-. '------------Liquid Depth--- - -____-------- •-- -..q ....• �,.,..,. Capacity..-1 --- ---------- No. Compartments--------A------- --- Distance to nearest: Well-------------------------------------------:Foundation.--./__0---------------Prop. Line._'---.---------- �I LEACHING LINE [ ] No. of Lines---- --------------------Length of each line.-5'__ ,0------- _.---_.Total Length. .----- --- - 'D' Box----/-------Type Filter Material__L,6�-V,,g j�tepth Filter Material____- ----_..____ Distance to nearest.. Well----------------------------Foundation-- ----::-----------Property Line----' :-------------------------J ' SEEPAGE PIT [ ] Depth-----------------Diameter-------------------.Number---------------------------------- Rock Filled Yes ❑ No ❑ WaterTable Depth--------------------------- ------------------------------Rock Size------- ---------- ------------------------ -- Distance to nearest: Well-------------------------------------------Foundation--------.-:--------------.Prop. Line------------------- ------_ REPAIR/ADDITION (Prev. Sanitation Permit#=----------------------------------------- =-------Date----------.------ ----------------------------- 1 SepticTank (Specify Requirements)--- ------ --------------------------------------- --------------------------------------- --------------------------------------------------- DisposalField (Specify Requirements)---------------------- -------------- --- -- ---------------------------------------- -------------------------------------------------------------- --- ------ -- - ----------------------- ----- , } - r (Draw existing and required addition on reverse side) hereby certify that I 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 that in the performance of the'work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed----- - P-Ozeo_xll� ---------------- ----------------------Owner Brs - � = -------------------------------Title---------- -- -------------------------- --------------------- ' (If other than owner) FOR DEPARTMENT USE ONLY ✓ w DATE...- APPLICATION ACCEPTED BY- r DIVISION OF LAND NUMBER.---- -- ---- - .. ----------------=-DATE--------- ------------------------f- ----- - ADDITIONALCOMMENTS--------------------- ---- ----------------------------------------=-------- ------------------- --------------------------------------------- ----------------------- =-}--------- -------------------------------------------------------------------- ------------ -------- ``-Tal Inspection bY---------- .. {' ----------------------- ------Date � /��m��✓ if/� �-- '£ ��, � F&��EV. 7/76 3M 24 SAN JOS UIN LOCAL HEALTH DISTRICT