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FOR OFFICE USE: FOR OFFICE USE: L APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit--------------------------------------------------------- ---- --_..--- __ ba -----------------------------------------_-_.._.-_ This Permit Expires i Year From Date Issued Date Issued- -4217.?7 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/ OCA N -L-- --Z-- .-7------_/----- (LCK__ lYt ty__. -------------CENSUS TRACT..........------------------ Owner's Name__-_ ¢ Phone "Address -- ----- 7 Z �' /- 2 .��' - -City# ' - Zip----- - -- ----------- ---- Contractor's Name-- - - - ..--.License # sJ5 ;?�2_2n Phone- --------------------- -------- Installation will serve: Residence ❑ Apartment House❑ Commercial Trailer Court ❑ Motel ❑ Other-__-_tea Number of living units:-------- _--_Number of bedrooms-------_Garbage Grinder---__------Lot Size__-----a_X :...___...... .... . ,Water Supply: Public System and name -----------------------------------------------------------------------------------------Private [+]- Character of soil to a depth of 3 feet:' Sand ❑ Silt E] Clay E] Peat[:] Sandy Loam ❑ Clay Loam ❑ Hardpan [fAdobe❑ Fill Material -----------If yes, type--------------------------- __ r (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 seepa pit permittedf ublic sewer is available within 200 feet,) PACKAGETREATMENT [ ] SEPTIC TANK [ Size- / _- ----%-/ _ /-----------Liquid Depth----- -___..-----------00 Capacity_/406-------Type--. i. a// Material---- ------_No. Compartments- � -- -----------.------ Distance to nearest: Well----- `` ---_ ---------- ---Foundation------V_47/,.-Z----Prop. Line-- -7,/- LEACHING LINE [�No. of Lines--------__--____.-__.Length of each line._ ....Total Length.------ -------------- D' Box----/_-----Type Filter Material-----5-(-`-_----__Depth Filter Material -------------------------------------------- ! ` Distance to nearest: Well--------6-::_0 __i_.-----Foundation------ 4-----:-----.Property Li-ne --------- !_----- SEEPAGE PIT [L]/ De th-_:-a- /Diameter_.__.3-3.----Number__----- 3 -___----- Rock Filled Yes _ _/-No_❑ Water Table Depth--------------�E1 -- - ------- ------------Rock Size-- i--------------- P� Distance to nearest: WelL_-___-_I-PP -�---- ---------.---,Foundation _ l6----------_Prop. Line-------J---------- - REPAIR/ADDITION (Prev. Sanitation Permit#-------------- ------------- ----------------------Date------------.:_____-_L_-_--__--_:__} `Septic Tank (Specify Requirements)---------------------- ------------------------------------------ -------- - ------ - _-----i Disposal Field (Specify Requirements)------------------ -----------------------------------------------------------------`------------------------------------------------ G --------- -----------------`---------------------------------------------------..-------------------------'----------------------------------------_------------'-----------------� L- - ---------------- . .. ----- --- (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 Count VOrdinances,. 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 Com lensation laws of California." Signed.--------------------------------------- - f ------------ - Owner — 1 LBy------------ --------- -- -- --- - -- /frs�-r�----- Title_ (If other than owner) _ - - FOR FOR DEPARTMENT USE ONLY `I b --77 APPLICATION ACCEPTED BY- -/ - ----------------------------.-..DATE- - - -/-77;;7- DIVISIONOF LAND NUMBER.-------------------------------- .------------------------------- ---------------------DATE.------------------ ------------------- -- ` ADDITIONAL COMMENTS------ ------------------ - ------------------------------ - -- - - - ------------- ----------------------------------- ------------------------------------------------------------ - --..Y ----------------- - - - -- ---------------------------- �Final InsP ection b - Dare Fas z1 ev ]/]6 3M - - ._--------------- --------------------- ------- - ------------ LH H 13 24 SA JOAQUIN LOCAL HEALTH DISTRICT W R