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FOR OFFICE USE: ' ' ''� FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -- Permit No...-7 (Complete in Triplicate) --- ,��7. Date Issued.�..__....._..7 t --------•- ---•------------ ---............. --. 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 complian ay Ordinance No.549 and existing Rules and Regulations: i ��.,r.,-...... _ .��. -JOB ADDRESS/LOCATI ,-._.... .........._......- . . .... j. .................-----........_..CENSUS TRACT Owner's Name.......... .. - ! y Address...... � Zip_F F � one - ---..._- .. . _ - .y. :.4. ---t::-•�- �C;ty c•+•'r•�_ZL!�C. Zi D� .,... Contractor's Name_.:...... . : `......__._:License*f+�'!._.: ._- Phone... L- �d7_:..,. Installation;will'serve: Residence❑ Apartment Hoce ❑ Com.- --^�rcia Troiler Court❑ Motel-C7 Number,of.living..units:......... Garbage Grinder......•_,.E.Lot,Size:-.<.,..:..:.i_.. _..._,. -------- WaterWater Supply:.Public System and name.1_,_r.__-__-- _____________ •. -.' ----� -P I �. -5 - _ --..__�.,-,. .. - �... -- -•• Private Character of soil.to a depth of 3 feet-r Sand ❑ Si1t��'CI y❑'`P a'rj—Sa cty Loam E] 16yLoam ❑` ' - .- ............. ---•--. s i Y 2 w•. • Hardpan E] Adobe. Fill Nloterial___..`�. .If yes, type :t ! (Plot plan, showing size of lot, location of system in relation towells, buildings,*etc.must be placed on reverse side.) ' sl .._ .�......p. ..pe. r-n.ii.._ . , t......:.... ,... NEW INSTALLATION: (No septic tank or seepage pit perm�ttecl if public sewer is available with;r 200 feet,) PACKAGE TREATMENT [:). _ s. ..`. },.. _ i.. .. ,... i- [ l SEPTIC'TANK ' ) Size----='..---------- -•-•-----t ......................Liquid Depth,.---- � ►. Ca acit J .. a _4 P y-_-....-.:: rType___r_._,,:. -____...Material..::•:. •_�� .. -No: Com' poEtments..-:_. / .__ ._..D.istance to nearest: Well.'......_!......:.. ....Prop. Line.......... --_--_-:-- LEACHING tWE= [r) No, of Lines................ cf.each fine;._s.,.:_;..., _- _-� i fiotal.Length , - r �..... .._.. i i -------- D' _ t �D Box....__ Type Filter Matenal i- r .Dept to Material. ....... ...... ................... --- s..._T t h Filter t Distance to nearest: Well........:......... Foundation__......_°_.__._i_....:_.Property Line--------- .... ............ .,!_, SEEPAGE PIT J Depth_ ......... ...:......:...................... Rock Filled Yes ❑ No' ? Water Table;Depth--- -- .. Rock Size..............i.... Distance to nearest: WeII i._-- ..•::_;._=_::i---.-_s_:_ "" i ' -.•-_-....Foundation..':-.-.••----------------Prop. Line._._..__:....-:-----.._.. REPAIR/ADDITION•(Prev°Sanit #� :, i * i- + : a _ • ...• anon Permit -#.:, tic Tank (Specify Requirements)--- .................. Disposal Field (Specify Requirements)..: -- -- .--:.` !._._. _g,�.X._ -.0t7"i.2.c ---- ..........-------- �y •-.. ............. ..... ...—............................. -----•••••.. --.:................._. ......-- ' s .... ........................... .........................>.... (Draw e_cisting'and required additionton reverse side) , I hereby certify that•1 -have prepared this-•application-and that`the work will- be-done In accordance with San Joaquin County i Ordinances, State Laws; and Rules*and Regulations of the' San Joaquin Local Health District. Home owner or licensed agents sig iature certifies the following: I certify that in 'the.performcrice of''tho work for whlihi tfiis permit is Issued;:I shall not employ any person in such manner as to become,subject to Workman's Compensationl.Jaws-. 1 Signed.:... __ ` Ow By------ -'---;----• = _ _ `.Title _ _------- - .-.---... �S (if other than.owner) +_ .p...',.>.._r......, . ..:.."i:... : :w ;«.:._; n j a "FOR'D ARTMENT USE ONLY' + f # APPLICATION ACCEPTED BY.._ _ _..... -: ------------------ = +' :..°...DATE..•_ •�..7. _. --••---/--•-- ' A--- ------------ . _..._ ._..... -• .._.-•-•--•••--._._...DIVISION OLAND NUMBER._ . ..ADDITIONAL COMMENTS _._.. - �_... . .. _. . ---- •..............•.. ---- • . .... -- i - . J ` _ - ................................. -------- -- ---........•-••------- - --: ---•• -•- = -----"" .. _ _y Dot . -- _..Inspection by - DISTRICTFos 21677 REV.717S.s.nSAN JOAQUIN LOCAL HEALTH . i ;