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n FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No._ _7– 7/3 --------------------------------------------------------- �.�-------- ------------------------------.-._--..-..-------_---------- This Permit Expires 'I Year From Date Issued Date lssued__ 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: J ] JOB ADDRESS/LOCATION..-1- �"� 1 6-I-4,"- 1-14 ST- -----------------------------------` - - --------.CENSUS TRACT---------- - ---- ------------- Owner's Name' 1�ETE�E --------------- - .` -----------------.Phone._ Addressi------ =---------------- City------ -------------------------------.: - -----Zip--- Contractor's Name- ] - -,'- T�Ul.5_4.4-. I�� _�.._ ��)(�t-------------License *-799 3 '.S------- -__fes ---- Installation will serve: Residence Apartment, House.❑ Commercial ❑ Trailer Court ❑ . .- Motel Q Other- =------=---------- ---- - ------ + Number of living units:-------- of bedrooms .--�-_Garbe e.Grinder--_-_-_.-___Lof Size___- ` t l - - i Water Supply: Public System and name----- " � iW— i-- --------------==----- - Priva#e ❑� z ------------------------ --- - Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ - Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material--.---------If Yes;type-----------------'--------------- i (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 seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK ['] Size = -- = -----Liquid Depth------- -------- Capacity------ Type._------------------ .:Material ----- -- No. Compartments-='---------------------- ---- Distance°to nearest: Well---------- ' f --------------------=-----=Foundation -----------------Prop. Line----------------------- LEACHING -- -------------- -LEACHING LINE [ ] No, of Lines____._:_ :.---.ILength,of each-line..---.____ _______________Total Length --------- ---------- 'D' Box-'=--- -----Type Filter Material--------------------- ------------ ----.Depth Filter Material---------------------------- ------------------------------�---- ., •, .. .. _ . . _ ---- ,.. Distancato nearest: Well---------------°------- Foundation---- _-------------_._..Property Line-------- ---------------'----- -]#- SEEPAGE PIT [ ] Depth ' '.__Diameter._-----------------Number-----------------__--_-_---_____ Rock Filled Yes. No Water Table De th -- " Rock Size- - ---------------------------- =-------------------------- Distance.toWell— ' nearest: Well—----------- ----------- ----Founda#ion------------------------:Prop, Line--------------------"'--- REPAIR/ADDITION (Prev. Sanitation Permit#___________________________________ ------______:Date.-_._-- Septic Tank (Specify Requ ri e19y sf L0 -----NORM_ 046-T----- a T' Disposal Field (Specify Requirements)-- _. _;. - -- --------------------------------------------------------------------------------------------------------------------- ---------------------------------------=----- -------------=----------------------------------- (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 County Ordinances,. State Laws, and Rules and Regulations of the' San Joaquin Local Health District, Home owner or licensed agents signature certifies the Following:" i "1 certify that in the peif frhlance' of'the work for which this permit is issued-"I shall hot employ any person in such manner as to 'become subject to Workman's Compensation laws of California." ' I Signed E s--- ToC-{ ---=--- --,---- - -. --Owner . BY . . ------. _.Title-- --'--------------------------- (If other than owner] ------------------- FOR --.-----FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY t DATE ---------------------- DIVISION OF LAND NUMBER:. ---- = DATE- -- ------- - ---------------------------------- - ADDITIONALCOMMENTS------------------------- --------------------------- ----------------------------------------------------- --------------- ---- ----- ,,_._r ------------------------------------------------ ---------------------------------- _______________________________________________________ __________-_____-_____________------- .__---------_-._r --__-_71 _------------------------------------- ---------------------- 4-- _ ___ ._________.___ Final Inspection by:--- =" = "` Date _ EH 13 24 �-�---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT Fes 21eZ REV. 7/76 3M