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. FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------- ----- (Complete in Triplicate) Permit No...77-- -7�__ ---------------------------------- ---- -------------- / 77 Date Issued__.II.__�_....... -------------------------------- -- 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 thework herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO � S- G- �_ CENSUS TRACT - , Owner's Name-=-----: 15�--- -s�-----------=-- --------------------------------- ------------- --------------Phone- % - -- - ---------------CitY �j ` --- ZipAddress--------------/.5 vo-- - --------- _ c / ' Uf PhonContractors Name _ Z � License #,P. Installation will serve: Residence Apartment House.❑ Commercial ❑ Trailer Court ❑ -Motel: ❑ Other------ - --------------------------------- Y - Number of living units___ __________Number of"bedrooms._ ____.Garbage Grinder_= _._Lot 5ize._. ------ . _-.---.. _.,_-.--__.__.____._______ Water Supply: Public System and name--------- =----------------- --------------------------------------------- ----- /------------------------------Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam El 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.) ' NEW INSTALLATION: (No-septic tank or seepage pit permitted if public sewer is available within 200 feet,) � `tel !� = - -�i uid Depth."� ----------1 - PACKAGE TREATMENT [ ] SEPTIC TANK"'[T]--�"`�-�--�--="Size.___. _ � q _ . . ---------No. Compartments.--.. Capacity a/rt�ments.-_` .Capacity ------Typ �� u _Matera -------.-------- --- - — Distance to nearest: Well _ __ _________ Foundation ----- --- Prop.�e ---I ---------- LEACHING - --+---LEACHING LINENo: of Lines. Length of each line T __A .______ _ _____________ 'D' Box. /.---_-Type Filter Material_/�` � D �e thFilterMateria --- --------------------------------- Depth. , � Distance to nearest: Well_ cL1_�__.___ ` Fbundation.C� ________________.Property Line__�6 --------------------- .� SEEPAGE PIT [ ] Depth----- --------Diameter__.......... Number_____ Rock Filled Yes ❑ No Water Table Depth-------------------------------- ------------------------ - _ .. G, Rock Size i l E Distance to Nearest: Well. s -------`-Foundation Prop_ Line -� REPAIR/ADDITION (Prev. Sanitation Permit#----------------------'-----------------------------Date------------------------------- SepticTank (Specify Requirements)-- -- -----------------------------------------------------I ------------------------- -------------------------- 'Disposal Field (Specify Requirements) :s `: 1 :-- -.----- " - --- A-7-Ir s -----•-----•------------------------------- ------ `":_f ''' =.- a 41 € -------------------------------- ---- ---------------------------------------------- ------------------------------ -: (Draw existing and required dddition on reverse side) I hereby certify that'll 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 LocarHealtFi District:-Home� owner or licensed agents : F signature certifies the following: ..I certify that iii_ the performance of-the work for which this permit is issued, I shall'not 6nr plcy any person in .such manner as to become subject to_Vorkman's Compensation' laws of California." t Signed--.- -z� 'C Owner BY- ----------- --------T------ ---------- i---------- -- -----------------------------------Title--------------------------------- ---------.---------------- ----------- (If other than•owner♦ FOR DEP RT ) l � MENT USE ONLY APPLICATION ACCEPTED BY-?--- --l- - ----- ---- ------- ------- -------------------------------- - ---------•------DATE.-/�- y : ------------- DIVISION OF LAND NUMBERZ.--------- = :-:-DATE ------- -------------------------------- ADDITIONAL -- --- --- ADDITIONAL COMMENTS-----:------------- ----------- ----------------------- -------------------------------------.z -^ ------------------------------------------------- ------ --- A _. '_________________________________._. - ______ .._ _____ ______________________ _._____-----____-_____---_-----_----_--_---_-_--________----_--.______-----_.----------------------------------------- --- Final Inspection b --------------------------------------------------------Date EH 13 24 SAN JOAQ IN LOCAL HEALTH DISTRICT _ Fas 21677 REV. 7/7