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FOR OFFICE USE: FOR OFFICE USE: P APPLICATION FOR SANITATION PERMIT ------------ ---_.-------------- 7i-/�/ ;.4; (Complete in Triplicate) Permit No______________ ________ _ ----- 3-tea_ 7t �• -, Date Issued.___________________ _______ *___ ----_ --------------------- -------- __ 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 described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: _ JOB,ADDRESS/LOCATION---------- -- -- - 5- ��--/W_.___.CENSUS TRACT------------------------------ / Owner sName.------- -I-- . - --.-.:. � �,�-S.�'-�-----=---- -----------,�;�.-`- -- -- ----- ------- - ---: _. Phone---- _�` --- -�l Address----------- 2_/ �ZP0 `� ------ ' - City 1 _.. y / ZiP Contractor's Name__:-....-+ f?rte' -_-. �GL� �i10 �_._____._._,License #-` ..C�__=..S + Phone__ �� -�_.s7UL! Installation will serve: ' Residence)Z Apartment House-E] Commercial ❑ Trailer Court ❑ f. Motel ❑ , -u :.-- -- ---- Number of living units:------ Number of bedrooms_. .__Garbage.Grinde.r._-_t._ Lot Size-------- --- -------- �-!��_`'��__.____4___ Water Supply: Public System and name_=__ _--.--.=_� U `--f� _ _s ____________________Private Character of soil to a depth of 3 feet: Sand Silt❑ Clay`❑�f,'P at❑N,' andy Loam D; Clay Loam 0 ° w _ - ..i Hardpan E' ] Adobe ❑ ' Fill Material-N�--------If Yes- --------------'------- (PGt 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,) ��wwyy r i r �cJ PACKAGE TREATMENT ( 1`; SEPTIC TANK [ 'I' Size----- ��P-�.. ------------- -Corn �-___ __ S`_Liguid=Dep#h °-----.._._ .:_ ___. Ca acit -_ .-- P Ya Type "_Material. d. No:-Corrt�artments i . Distanceao nearest: Well-:.-__ (� .. .-__- _.-____- _�Foundat•ion__- ____ __________Prop. Line._ _________-._ - e �;.Y_ - ..gC..- - �' ..,y `` ! , LEACHING LINE [_] No. of Lines.=-.-- _ - — - ------ th Filter Ma_tenal.___.___________________y-----------------------:------_-__-- !en th of each line. Total Len #h.-_=-_-- lam________________ D' Box-__ i..Type Filter Material___ � l Distance to nearest: Well_-_j� _ __Foundation___ __ -----------Property Li SEEPAGE PIT [ ] Depth::__'-___.. Diameter_. _____;__._-----Number_-------- ------------------- Rock Filled Yes ❑ No ❑� t Wat .. f er.,Table Depth------------------------- -------- -----------------------Rock Size Disfiance;to nearest: Well_ ----------_--------------Foundation--------------------------Prop. Line------------------.._ REPAIR/ADDITION (Prev. Sanitation Permit#--°---------- ------------- --- _�Date=._.._,_.___.__-_------------------------------------- Septic Tank (Specify Requirements) '---------- --- ------ - -----=--------- ---=--- - ----=------------------=--- -. '. -;3 Disposal Field (Specify Requirements) -7-----=--------- - - ------ ----------------------------'--------- ------------------------- k- ------------------------------------------- -- ------------. _.-- ---. - - 1 ----------------------------------- -- --- ----- - --- ---- ------------------------ -------------------------------- i (Draw existing and required addition..on'reve se side) I hereby certify that have prepared'this application and•that-the :work-will-be'done�•-im-accordance-with-San-Joaquin County y Ordinances, State Laws, and Rules i}and Regulations of the San Joaquin Local Health District. Home owner or licensed agents signature certifies the following: 1 "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. Compensation laws of California." Signed-------- --- -- ---(.� - :====Owner ;- . . mss::- -. .., , BY tl --------------- ;Title ------- - (If other than'.owner) FOR.DEPARTMENT USE ONLY , APPLICATION ACCEPTED- BY-------'------ -- ------ - - ------------------------------------------DATE _.T Z,0.- --------- ._`. DIVISION..OF LAND NUMBER. ----------- - DATE . . ----- IADDITIONAL COMMENTS--------------------------------- ---- --------------- ---------- -------- -------- ---------------------------------------------------------- ` ---------------- ----------------------------------------------------- ----------- --------- ------------------- --- 4 ------- --:------- ---------------------------- ----- ----- -- -------------------------------------------- ----------- ------ ----+ . .. - -------------------=-------- = bate -- Final Inspection by:.__I/`'- -' -----=-- -- - = � 'r-------------- ---- ------------- ---- EH 13 24 SAN JOAQUIN, LOCAL HEALTH DISTRICT F&S,,2g6 REV. 7/76 3M