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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----- --- ;7�-s -X� {Complete in Triplicate} Permit No....................... ----------------------------- ...-.-..................... Date Issued- ......-••••-•-•• ................- ------------------- This Permit Expires 1 Year From Date Issued - I 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 complionceiwith County Ordinance No. 549 and existing Rules and Regulations; JOB ADDRESS/LOCATION...... /144V494. ../wc.--------------------------------------------------CENSUS TRACT.---------------- ---..- Owner's Name... . ,��. es. [.�)Cq�l G4.: ----- --- -------- -------------Phone.-.-....------ ---------- --`--------- Address..._ ---- _--Address------ _=54414F...4F... . i --. . � -------- ---- - - -- = --- - --- --------- ----CtY - Contractor's Name---.- --- -- -- .....Phone_4, -�—Z------- i Installation will serve; Residenc� Apartment House ❑ Commercial ❑ Trailer CourtIlk ❑ Motel [❑ Other--------------------------------------- ----- Number of living units:...... -------Number of bedrooms. __Garbage Grinder-_e0._.-Lot Size--_54 ...... .......... .. .. Water Supply: Public System and name.!...: 1 . :- -- --- - ---- -- ----------------------------------------- --- ------Private ❑ t i Character of soil to a depth of 3 feet: Sand ❑ -Silt❑ Clay ❑ Peot ❑, Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adob Fill Material - ..... ....If yes, type-•-•------------------------- - , (Plot plan, showing size of lot, location `of system in relation to wells, buildings, etc. must be placed on reverse side.) .J NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,j F _ :. PACKAGE TREATMENT __.-_-.---- ------Liquid Depth------------------ -- [ Size -..--/�`�_.��eL__.._ ------ Capacity.. 0......Type- dex 1_55..Material- S7�P,#�stSS:No. Compartments.-@2 ------ ------------------- I Distance to nearest: WE Foundation-__—et,_1 .,_ .,.-.-.Prop. Line..-_. .-_----_..- LEACHING LINE [A No. of Lines .._�.----- . Length of each line .__-�.__ Lengt �p- --.___.--- / 'D` Box_.�a....Type Filter Mote rial., .Z..Depth Filt4teriql.-.,��-- _ _------------------ ----- ---- -------- Distance to nearest: Well-- 4a.. �-_...Foundation.__oZQ- - .--:--..Pr perty Line.... e pr ............... SEEPAGE PITp ' Rock Filled es ❑ o ❑ [ i De th--�-- ..,_.'_.#Diameter----•-------- - --.Number-----------------;------------ - N -�+ Water Table Depth-----1--- ----- --- ----- ------------------Rock Size.'- ............... - ------- � Distance to nearest: Well---------------- ----------;--- ----- Foundation--.-.-- --- ---..-._.Prdp. Line----- -.------- ---------.-. . c.l , REPAIR/ADDITION (Prev. Sanitation Permit#---•---•'-----:--:-'-------------- ---------------[late._.._-------- ----.?--.--:----------...------------------- Septic Tank (Specify Requirements).-----Ii...i..... ...-- S Disposal Field (Specify Requirements)-:;.-'------------------ -- ---.-..------- _ - .- .----_---. - ............................. . ..... ------ ------------------------- .......------------------------ -- ------ ------ I f t(Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will bei done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Loyal Health District, Home owner or licensed agents signature certifies the following: " s f "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 subje t to Workman's Compensation laws of California. i s : Signed ..:-..... - Owner $y... Title. ---------------------- .... ------- .................. i (If other owneri f F i TPR DEPARTMENT USE ONLY -7 APPLICATION ACCEPTED 'BY----------- DATE _.. d..7k.. DIVISION OF LAND NUMBER-------------- -` ........................ =-- 2. DATE.... . ...... ADDITIONAL COMMENTS---------------- ------ -- --- - ...... --- --- ----------------- --- - ------------------------------------. ------------------------ ------ ---------- ------------ --- ---------------- ---------- -------------- --------- - - ......- / -Date...-_._. . g Final inspection by:.................. Irl--. EH 13 24 S JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV, 7/76 3M ;