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i FOR OFFICE USE; FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No....._ ".1.: 15-Zft --------------------- F ------------------- --- - Issued..b.":z�x.34-- '--~ ...... This Permit Expires I Year From date Issued Date application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. his application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: J08 ADDRESS/LOCATION...... .__ . �._ .... - ....c . .. ... . ...... ......... .f...--. ---------------------- ---------.CENSUS TRACT. -- ------- -�-------...._ Owner's Name _ L.:_".. . ....... . • . . .............. _.. �Prhhe.�; > _ ----- 27 Address_.... ...... Ci ty Z i P ontractor's Name ........ C $ ....... ...... ...License Phone.. .,.� i �stallation will serve: Resi encu' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other............... . . .. ...........-. _--._Number of bedrooms.. g dumber of living units:.___ � l r�... Garbage Grinder............Lot Size..". ...:....- ..`.... � .-. .Vater Supply: Public System and norne------ ------------ ----- Private, Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ a Hardpan ❑ Adobe 6W<' Fill Material._ _ If yes, type.......................- ....... lPlot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) ; C"iEW INSTALLATION: (No septic dI ank or seepage pit permitted if public sewer is available within 200 feet,] �. 'ACKAGE TREATMENT j } SEPTIC TANK [ ] Size ______ ._ . ___ -..""..............."_Liquid Depth------.._..-..._.."........ � Capa[ity-....-II - - -----Type-------- -----------Material..................... --.:No. Compartments------------ ---------------- r Distance to nearest: Well... . _ ................ .. ... .....Foundation...---.._. . .............Prop. Line----................-... -, LEACHING LINE j ] No. of Lines; ----- .Length of each ling--------------------------_..Total Length .......................................1-4t 'D' Box---.........Type Filter Material................... Depth Filter Material.....-...------.--- ------------------------------------------- Distance,to earest: Well --------------- ---- ---- Foundation---- -----------------.._Property Line.................................... SEEPAGE PIT ( } Depth L. Diameter..-----------.......Number.------------------------------- Rock Filled Yes ❑ No ❑ Water Tablet Depth--- -------------------- --- ---- ---- --- -------- Rock Size.- ----- ........................ - ------ Distance to nearest: Well................."_............"......""-.Foundation..........................Prop. Line........-.-.----------_-- EPAIR/ADDITION (Prev. Sanitation Permit#----------------------..................-..........Date_---------........".--.-..--- -- -----------) j Jeptic Tank (Specify Requirements)... I- f F, 4 -- Disposal Field (Specify Requirements). —... _ . .i42� - ----- (Draw existing and required addition on reverse side) r 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 rignature 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 o become suble W rkm n's Co pensation laws of California." igned----- .... _Owner F By. ----------------- -------- ----------- I� s Title.. =: .............. ........... ------------ --- (If other than; owner) } 1 F R DEPART T LIE ONLY € • APPLICATION ACCEPTED BY........... . == '`s" =A.:"'°t rr.,! -- --- ----•- ...................DATI ._..._. ._ .. - t DIVISION OF LAND NUMBER.............�..........""..... ..... ....DATE...... ---......... .... .. ..._....".. ADDITIONALCOMMENTS- --.....---.............................-- ----------- --- ------- .............................. ........------- -=--- -...--- ---------------- ........... -------- F-- ------------ ---------------------------- ----- -- - - ------------ FFinal Inspection b y:....- -------------------------------- ------------Date.- 7 -f...... ... EH 13 �' �; SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 216777 V. 7/76 3M