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' r FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT S' --- +L 7-0 Permit No..7 `� 5 (Complete in Triplicate) ' Ow tJ '27P On. <51/ li a Issued---6--- ----19 --- --- .................... ....... . � 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 ism -i compliance with County Ordinance No. 549 and existing Rules and Regulations: � waX. .. JOB DRE S/LOCATICN. T� ..... �...._. _..---.....___..... CENSUS TRACTS--- --------..%._ � ,,`` aa Owner's Name... � . / �� .C�l .i __ :.. - --- --------Phone .--`J c� aZ . y + 3 2------- --------------- Address.... ----.-- --- S �.city ....... .. Zip.O . .Address Contractor's Name fly��4"'-S.EL/ .._ .......... ------------ -----License #............................Phone........ . --------- ..-- Installation will serve:' Resilience❑ Apartment House.❑ Commercial ❑ Trailer Court E]Motel �❑ (5 her her . - Number of living uriits:i•.__�."'._.___Number of bedrooms..-- __._Garbage Grinder... ........Lot.Size....____ __" __ C'•!��'��-.. Water Supply: Public.System and name �_. ..... ........... Private ❑ Character of.soiho a depth.of 3 feet: Sand E] Silt' ❑-_ Cloy❑ Peat[]. 'Sandy Loam W__11CIay loam L] Hardpan Adobe[j Fill.Materiol If yes, type_... ------ ............. {Plot plan, showing size of lot, location of system iri 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�foeet,) PACKAGE TREATMENT [ ] SEPTIC TANK f��• Size...../-20 0"____a,4—-- -----------.Liquid,Depth........... ...... . Capacity/ C� !:�TypeOXf7 -------No. Compartments. 4 )LDistance to neare t: Well ... �a4__ _ t �....founc�atiopri..-__r� Prop. Line :..._ __.__/..._.. . LEACHING LINE 1 ,1 No. of Lines .---_ ....?. -Length each line _.."�/"O--_.Total Length . I -------- :. .' � 'D' Box. . Type -.Z7L2-�e th-FigferMaterial----�.1...... ... .....:- �..""T e Filter Material/ ..�. garb, 7.6, trM-7- -jistancetonearest: Well �QQ.._-- ... . ._.------------Property, Line:.... . . ....................... SEEPAGE PIT S Depth.......... ... Diameter.............. Number........ Rock Filled Yes ❑ No ❑ Water Table Depth-------------_ . .............•...... Rock Size :1�...: yX/G 6 f Foundation"-.... _ _-.-.. ... Prop. Line _ X Distance to nearest:'Well................ :W REPAIR/ADDITION (Prev. Sanitation Permit#. ....................... . ---••-Date ; ...) Septic Tank (Specify Requirements)......... -• . t...........................,...: .._.---------::........ ....................... ............ .....r---- - .-.."------------- Disposal Field (Specify Require ents) .. _- ...... zvi .................. ...-•-- . . ................ .._....... . -------------------- -- .....--- . --- - (Draw existing and required addition on reverse side) hereby certify that I hove 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. Florae 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 �* bject to Workman' Comae ati laws of California." �Signed. lG.... -....... . .. . . ..... ... .... .......---- ...... Owner By.!......... ______ .........Title.......... -_. :--:..... ] (If other than owner) I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.:..... •--- .. ....... ••---•....... DATE ...0 DIVISIONOF LAND NUMBER.. .................... ..................... ...•..._ ........... -----------:---DATE............... ----- ...... ADDITIONALCOMMENTS........ .. ............................................................ ----- ----------....... .......................... ................................----------------------------• ........................ . .................. .-...._................... ............................................... .................................... l...__. -_.._.e-_- .•.---------......._.._...._..............._....... _ .....•Final Inspection by:._ - .. .................................................. EN 13 24. SAN JOA IN LOCAL HEALTH DISTRICT Fa 21677 REV. 7/76 3M