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FOR OFFICE USE; FOR OFFICE USE: APPLICATION FOR S&NITATION PERMIT ----------- ------- ------ -------------------- Permit� 7 9 (Complete in Triplicate) No...-...--- Date Issued._ .----� r .... This Permit Expires 1 Year From Date Issued I 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.� 7 ...../io.� '-,�d�L.� > ........... �4. = .CENSUS TRACT_...._.... Owner's Name. N.1C„,, /*' - / Q ...."................ ............ ••b-.-• ......--..._Phone'i��.e�. -... Address /l�'- /..c��G-fl...jr ------------ CitY � Zip- ,S-a?-� Contractor's Name----------------- / ...License # Phone.......=----------------- Installation --- •- -- � Motel "p"-- e ;lir... E] .. - -.......... ❑ ❑ cruse Commercial Trailer Court V1 ' o Othe . ....._ . _ nsta a#ion will serve: Residence A artment H Number of living units______ ___-------Number of bedrooms--..S.- ..,Garbage Grinder.__&/.....Lot Size---------Z..Q.... .......... .. Water Supply: Public System and name.. ....................: .. ......................................... ——---------------._._.Private ----------------------- - - Character of soil to a depth of 3 feet: Sand Silt p ❑ ❑ ' Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ' Hardpan Adobe ❑ Fill Material . .... ....If yes, type................................ t [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.] i NEW INSTALLATION: r(No' septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK ( ] Size...... ' fff �irl_,a_�__...... - - Liquid Depth��.:..�.._..-._.� ' ;�Capacity��. -----.TypeX-r�.......Material.-614 Z. -No. Compartments.._-------- ------------------ T Distance to nearest: Well----------- d.:. ........ ......'..Foundation---,l�. . Prop. Line---- LEACHING --- ------- a / a LINE [ ] No. of Lines ____. g '�i0 Total Length _. .� ._.. . ................:.Len Length of each line ................. .. �_. . "' 'D' Box -/-.....Type Filter MateriaWtV/do(. 0 Filter Material__-._-/7."--..'---...-----.----,....................... . Distanceto nearest: Well._. ' ........Foundation.__. __..7�":......Property Line...S_._. .............. r 4 t SEEPAGE PIT ( ] Depth_ .....Diameter..,�.jl�_(__Number.._..., =___ :_r__.. i_. Rock Filled Yes ❑ No 1 >a Water Table Depth........... j. .- ....... ... Rock Size /- .... Distancetoto nearest: Well------ "�..............Foundation..Aw.�74 iProP• Line---- ...i_y...�. ..._.__._. _I „ REPAIR/ADDITION (Prev. Sanitation Permit#................................... ----.--------_Date--------:---------- ---------------------------- Septic ._.------..,- -----Septic Tank (Specify Requirements)................ Disposal Field (Specify Requirements(...................... .. - .” -------------'---.-------- - ---------- (Draw existing and required addition on reverse side) I 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 becom�biect to Workman's Compensation laws of California." Sign ." `t- .......-I----------- Owner BY-".................................•"--••"""""""_..._ Title -------- """"- -------------- (If other than owner) r FM DEP TMENT USE 9NLY — s APPLICATION ACCEPTED BY............. r DATE ..� .../�. - DIVISION OF LAND NUMBER.-"----" - ------ ---------- ...............- - ---------- DATE.------------------.-' .... ....... : ADDITIONAL COMMENTS........-"-.......... _--- i 4 ................-------...'-----------------------'-----..........-...------------------------------------------------ ------------ ...-------- ---------........v......._._................. Finol Insgcnon by: Date - ... e :...�� ----- - er+ 13 24SAN JOAQUIN LOCAL HEALTH DISTRICT F8S 21677 REV. 7/76 3MF