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ti FOR OFFICE USE: FOR OFFICE USE: APPLICATION FAR SANITATION PERMIT �# --------- ---------------------- -- ----------------- g -5^73 (Complete in Triplicate) Permit No_ ________.___ Date Issued__77"-3_ •------------ ------------------ ------------------------ 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 descrilied:�. This application is made in compliance with County Ordinance No.549 and existing Rules and Regulations: JOB ADDRESS/LOCATION.... --- --_ S ---.----.CENSUS TRACT. Owner's Name..---- - Phone Address--- ------ ........ _City-------------------- �• _. Zi A " Contractor's Name------- ± f �Jt � -- License #.__ Phone ----------- --.. _ --- Zc`Z ---- - Installation_will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ ..... Motel- r--- ----- _ k Number of livingunits______ __________Number,of.bedrooms.>_�t ---Garbdge Grinder.- ` ' - - Water Supply: Public System and name---- .__ ---- ----- ------------- rivateEr Character of soil to a depth of 3 feet: - Sand [] !Silt L] ;Clay El ` Peat[] Sandy Loam E] Clay Loam [� Hardpan ` Adobe.� 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.] r s NEW INSTALLATION: '`(No`septic fiarik'or s'ee s " PACKAGE TREATMENT it oc sewer is available within 200 feet,) pa p' permitted if publi [ ] SEPTIC-TANK [ ! / / Liquid g ' ._; a .,.. Size= r , - ---------- ' -- - iq Depth--- - ------------ Capacity_=l -tD :--.'Type. al No.-Compartments-.'------=�' , r_Materi �'-- - `-- ---- r Distance to nearest: WeIL:•----•------_7_/x:,,.- :-----'- --:Foundation.=--_� ---�•,-------Prop. Line--- ----------------- LEACHING LINE No. 'of Lines_,____-------------- -„____Length of each ling-------- --__ `7 -- ? Total Length.-____4• '�_-_.- 'D' Box _..___Type Filter Material_. __. -g_9 Depth Filter Material ------ I f `Q = Distance to nearest: Well---"------------------'----.Faundatian____ ---,----_ --Property Line------ ------- ------ 1 . -- : [ Oe th-._- -Di ameter_:------ ___--Number=--;.-----`---_--- ------------:- Rock Filled Yes ( No -..t.... . . �I �, ... P R f -. Rock Size ' ate- Table!De -th--- ------�-- - -------------------- - �-:-' i w Distance to nearest:Well.___.___'_-'___ _�__ = �T l --- :Foundation _:47 ---------.Pro p, Line (Prey:Sanitation Permit#-- ?--_.._______ ____ ------------- ---------Date__ .. t Septic Tank (Specify'Requirements)_-- ______________ �. Disposal Field (Specify Requirements)-- ------- ------ -------------- - r . ---------- = ------------------------ - - - - --- . --- ------------ = = - _ ---------- ----------------- ----- -- - ------------- (Draw existing and required addition on reverse side] ' I hereby certify that:l 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'rvhiih this permit'is issued,"1-shall hoi employ any person in'such manner as to become subject to Workman's ompensation laws.of California.". Signed--------=--- ' --- -------- -------- = Ow her--- ----- ------ her k � ' BY---------- ---------------- _Title , (If other than owner) 11 FOR-DEPARTMENT USE ONLY t I APPLICATION ACCEPTED BY--- - -- .. = - - - - --------------- - DATE.;---7 ~ DIVISION OF LAND NUMBER ---- ----------- DATE -' = - --------- -------- ----------- ADDITIONAL COMMENTS------------- ------- --- --------------- ------------------------- --------------- ---- ------------=------ - _ ---------------------- ------------------ -- ------r --------- - ------ - ---------------------------------------- ----------------------------- ---------------- ---------------- Final-Inspection by: --! - ------------------------Date- , r FH 13 24 "` -SAN JOAQUIN LOCAL HEALTH DISTRICT r&s 21677yPW7/76;