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FOR OFFICE USE: "+ FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT { ---------V - [Complete in Triplicate] Permit No. 7- ----- -- ----------- y f T7 r 2f Date -- !� ___________-- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Loca9f'Fie61th District fora 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/LOCATIO --- ------ / - -- -�--�--.CENSUS TRACT--------------- - -----------__ -.. Owner's Name------- ---------------- �� ck � ' ------. -------------------- - Phone- Address--------------------- --- ---- --- --- -:: ---- --------------------- ...City - zi - --------- --- Contractor's Name .L.0 f�.Lk4. - -- -----------------License #-"S Phone- -------0----------------------------- -- In ---- -- --- Installation will serve: Residence K Apartment House.0 Commercial ❑ Trailer Court ❑ Motef,-o Other----------- - ----------------------------- Number of living units:------I--------Number of bedroorrys -------Garbage Grinder------------Lot Size----___._ _J____--.--- ----------- ----------- --- Water Supply: Public System and name------------------'-o'------------------------------- ----------------------------------------- ------Private I Character of soil to a depth ❑of 3 feet: Sand �,'gilt❑ E] E]Clay Peat Sandy Loam E] Clay Loam Hardpan ❑ Adobe Fill Material___----- ---If yes,type-_----------------------------- �.r (Plot plan, showing size of lot,,Iocation of systerh inli=elation 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 fee#j PACKAGE TREATMENT [ ]_ .':SEPTIC TANK ( ] `' Size ---------------------------- ---------------------------Liquid D�pth._-----_-- Ca aCit �, --Type---------------------t-Material------------ =_' No. Compartments-=------------------------------ Distance to nearest; Weld-- --`------------------Foundation.------.-----------------.Prop. Line------------------------- LEACHING -----_---------------- LEACHING LINE [ ] No. of`k;nes-----------------" r---.Length of leach line.-----------------------------.Total Length ------- ---------/--°----------------- , i D' Box Type Fiber 1laterlial --------Depth Filter Material----------------- ----- '= <_ { _._ �1 Distance to nearest: W61l-_---------------- ----Foundation------------------------------Propert)(1f e'------------------------- ------------ ----- ` SEEPAGE PIT ;/ ] Depth----------------Diameter------------------------ -.---, -----_----_ %"lock Filled Yes ❑ No' Water Table DeptF1v: --------------------.----===:-- ---------------- ---Rock Size------- ------------------------------------- Distance.to nearest Wle -------j�---------'--------------------Foundationr_-_=---------------------Prop. Line---------------------------. REPAIR/ADDIT[ON (Prev. Sanitation Permit'#_�--_-------11 --------------------------------Date------------------------------------------------ Septic -- ---------:_---------_ ---_Septic Tank (Specify Requirements)------- = - Dispc al Fi (S.pedyRequirements) jOff.3 47 170r A`5Gt:r - - -� (Draw existing and required addition on reverseYe� � � �� herebycertify that I have prepared this a Cication and that the work will be done in accordance with Son``Joa uin County fY P P q Ordinances, Stat�'o`)Laws, and Rules and ROul�rtions of the San Joaquin Local Health District. Home owner or licensed agents signature certifiesffke following: "I certify that in We performance of the`.work for which this permit is issued, I shall not employ any person in such mariner as to becorn subject It or mans Compe tion law of California." Signed --- ------ fE Owner BY---------------------------- =` ---------- ------- ------- --- -.Title (If other than owner) 4!' G` .,,,FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ �L�._ --- -- ---_--DATE.------7-4-----'57-��----- DIVISION OF LAND NUMBER ---------------------------------- ----' DATE--------------------- ---- -------------- ADDITIONAL COMMENTS ___- - ------- ------------------------- ----- ---------- ----------------- ',S--�--------------- - ----- -- ------��G- ----- - y - O - ------ -------� ? Final b ------------ --- - ------- - - ------------------------------------------------------------------- ------Date..-- EH 13 24 S N AQUIN _. LOCAL HEALTH DISTRICT Fh5 21677 REV. 7176 3M