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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ............ ........ I ............._. .---- Permit No.79—F/:3 (Complete in Triplicate) �••• • -_- .. -. pp 1..: .7�'.7� .......... . ------ -- ..--.._ ..._ ... This Permit Expires 1 Year From Date Issued 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: l JOB ADDRESS/LOCATION.. d _ -».`..s • �,4r.R?� ��=J..G . OSS-vZrJ-7J _.. ....CENSUS .TRACT..--•- -- -- - � Owner's Name_ . ...... ......... .......... Phone ... .._ Address ---- ..�_ 4�5 }Z�t�4........___........-................................ ._Gty .. [O. {.(.4*1 ..........2ip .95207 Contractor's Name... IIJJ �............................License #--- - ........Phone............... ... ....... Installation will serve: Resit ence ❑ Apartment House❑ Commercial • Trailer Court �J Motel F- Other.. Number of living units:.......... Number of.bedrooms_...._ Garbage.Grinder. -.lot Size.............. .-_-..................... ] Water Supply. Public System and name .................. . .. --: ................. ........................ - ............ ....... Private ❑ Character of soil to a depth'of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat Sandy Loam❑ Clay Loam ❑ Hardpan ❑ -.-rAdobe ❑ Fill Material....... If yes, tYPe_.............. . I t (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) N NEW INSTALLATION.='(No septic tank'or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] ; SEPTIC TANK !� [ ] Size............. a-QO-................ . ._Liquid Depth--6,q. ---- - -- Copocity ..................Type ............._Material...................... . No. Compartments...2......... ------------ ' Distance to nearest: Well).�-O Q...........................Foundation...1.0 . Prop. Line.,?,5..... , LEACHING LINE. [ ] No. of Lines...........I---------:.. Length of each line......010.i.. ..............Total Length a✓ .....-__...... ............h j D' Box .........Type Filter Material....... .. ..Depth Filter Material...:............... . .............._-.................... Distance to nearest: Well........:... .. ..........Foundation .. . .............Property Line............... . ` SEEPAGE PIT [ ] Depth :... ......Diameter ..Number............ ....... Rock Filled Yes ❑ No ❑ Water Table Depth-------------I................................... Rock Size......... ..................... Distance to nearest: Well.......... '. . ' Foundation_.........................Prop. Line------..--.._-- REPAIR/ADDITION (Prev. Sanitation Permit#-____-..... Date _._:._......__._. _ ................ --•--------- ......... Septic Tank (Specify Requirements)... .._...-------•-_..................... : ..........._.. Disposal Field (Specify Requirements) - ..•........._._.___.•........................................................._................... --------- --------------••-- ------ .....----------- --- .................--..................- .. .... ....... 4 (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application-and that the work will be done in accordance with--San Joaquin-Cowity};( Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents ', signature certifies the following i "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 subject to Workman's Compensation laws of California." Signed._....-- - - .l7 ►� ctcm.S_.....-___-. ��6 ?. - - - ..:Owner ) BY ------------ — ` �......... .. ��V-s ' V'Q�l� -- .......... Title.....¢1. rra!^.-............ ... .............. (If other than owner) FOR DEPARTMENT USE ONLY �VPLICATION ACCEPTED BY C.,... - .._._.. .... ..........................---- ------• .. ......DATE F11_41.76......................... 'DIVISION OF LAND NUMBER_ ---------------- _-._.. .......................................................DATE .............................................. ADDITIONALCOMMENTS_........................... :...................................................................... ................................................ ...................................... ............................................................. . ........................ ............. -- V_ ............... ... ... .............................. ... ................. ...-------------------- ---.....--•--.............-----......------..................----••--.................... _ -. F .......... -.. _ .... ......... ........................ q p infil Inspection by:.........�.. . . .............................................................. .. . . = " -.- . _,_ Date .-9/1s� �d EM 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fas 21677 REV. 7/76 aA,%