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FOR OFFICE USE: FOR OFFICE USE, APPLICATION FOR SANITATION PERMIT Permit N0. 2?4-T,� -----• .36........ ...... ....*...._...,....._ (Complete in Triplicate) /// 7� ...... ...._............. Date Issued... •... . . This Permit Expires 1 Year From Date Issued .—. — pplication is hereby made to-the San Joaquin local Health District for a permit to construct d Regulations!i the work herein describe . his'application is.made in compliance with County-Ordinance No. 549 and existing Roles and Regulations: ..._.. * ..............CENSUS TRACT................................ JOB ADDRESS/LOCATI ner's Name.- Zi .. :._.... f..,... ..... ..City. '.. .. ..S ddress.... 5 �'.... ci ..- License #.. Trailer Court hone.......:............. ontractor's Name...:--." ❑ Installation will 'serve: Residence p Apartment House[I C m rct ❑ Motel ❑ Other_,-14 a rtnber of living units:..... umber of bedrooms. .A .Garbage Grinder........ ...Lot Size..................... " .....•......... ..........�ater Supply: Public System and name .....,...... . ............................................................".._..................."... •---....---------- pP y p Character of soil to a depth of 3 feet; Peat❑ Sandy loam... Clay Loam n Sand Silt❑ Clay ❑ ■ Hardpan Ci Adobe Fill Material., If yesr type---••-"---•• - ........... [Plot plan, showinshowing size of tot, location of system in relation to wells, buildings,etc. must be placed on reverse side.) , , V EW INSTALLATION: (No septic tank or seepage pit permitted if public sew Is available within 200 feet,) j� v+a Liquid DeQth. .: ...Ce.-....... Size ... O-O ` PACKAGE TREATMENT SEPTIC TANK �(1 1 ' ..... ..•• Capacity./J-ab, .Type,. IY'.-tp fMateriol_,C , .0C.�y.(--hNo� Companments....... 2...- . f... ..... Pro Line...... 5-..f..--" ..� Foundoti n p• Distance to nearest: WelL........?5?a . --•• - -•• s e? ...Total Length _ �� r6 . ..�-•- .U11,....!L LEACHING LINE No. of Lines .."-. .a..............Length off Bath line........... .. ._,.... 'D' BoxA.,Pb.. _I.... Type Filter Materia -0.J.Depth Filter Material...........r.g.................. J .._...-----.......... Distance to nearest: Well ...�•..r Q. .-- .. foundation........1..Q_:fn.. ......Property Line..... ..... F... -- .... ... ..... .. k SEEPAGE PIT l 1 Depth... ... Diameter....... ..... Number... Rock Filled Yes [:] No . ....... ........".Rock Size...... .... .........................,........... Water Table Depth ....................... ....... .... .....- ..........__.Foundation................._..... .Prop. Line.. ..... -.. . Distance to nearest: Well_._........................ �a k . ate. .T:-_,:..... ...... ..... ...........) .... REPAIR/ADDITION lPrev. Sanitation Permit#.......................... ..... ... ......... - _ Septic Tank (Specify Requirementsl....... . ..... ......... ....... ....... ...... . .. ...:...:. , ` Disposal Field (Specify Requirements, ...•. _- _ . „.................... ..:. ..... ...... ..... . .......................... . ._ ,.......- ..... ..............................._ . --.. (Draw existing and required addition on reverse s: e done in accord I hereby certify that l have prepared this application and that the work will be accordance with San Joaquin Count! Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District, Home owner or licensed agent signature certifies the following: p - I shall not,employ any person in such manner a "I certify that i the performance of the work for which this permit is issued, to become su a to Warkm comp�nsat: laws of California." .-.- Turner ._. Signed. FF{��///666 .d+C..�r-If .... ._.-..."..-... , (If other than owner) OR EPART NT USE ONLY , —' DATE APPLICATION ACCEPTED BY........... .... .. .(',� . .... ...... ............. .... ...... DATE.. .... DIVISION OF LAND NUMBER_ _..... - .......... .... ...... ..... .... .... ..... _... ... ADDITIONAL COMMENTS......_........_.....................I.............. ........ ....... ...._........................ ......._.._-_...................I......,........ .... . - ,........ . ............-.................._......Date..... -y `yt rs5 71677 REV.7176 . ._ s } rl . I I Final Insf>ecirlon by,...... ....... .... .-..... ... . 1 EH 13 24 SAN JOAQUW LOCAL HEALTH DISTRICT 'yr..