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FFICE USE: -- APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: (Complete in Triplicate) Permit --------------------- -------------- This Permit Expires 1 Year From Date Issued Date Issued./fp--/.}3=-?9� Application'is hereby made to the San Joaquin Loc I Health District far•a` er.mit-,o-construct and"insfalf the work herein described. This application is made in compliance with County' "; 4q e � �gulations: Lk 4�� JOB ADDRESS/LOCATION ---`---- - ------------------- ---------- - - --.-.. NSUS TRACT. ---- ----- ------ Owner's Name-- -- �� D--- -- -/? � - -- - -- -- `'rr � -------- Address-- a one ------------------------------- -- -------City- Name--- --- - � � -- -- - - -- -------- �-: - - . ._ -------- ------ ------------------------Z p ----------------------------- Contractor's f r�-z�-�aV---- License .%�_ �_�� on -. ;-� --- Ph e - sidence Apartment House,[] , Commercial ❑ Trailer Court ❑ nsta ation will serve: Re � , Motel ❑ � Ot.her_-}�"�'-`» �^s ._._--,-_-, - - � Number of laving units:._'-- -------Number of bedrooms._.- ,___-Garbage Grinder-------.,---Lot"Sze, x Water Supply: Public System and nam S4-1------ - I I �f ..� -------:'------ Character of soil to a depth of 3 feet: Sand Silt 'Clay ; Private ❑ ❑ ❑ ❑ Peat❑ Sandy Loam ❑ Clay Loam + s Hardpari30'""'•'Adobe-E] 'Fill-M—a#•e`rial7"''""f yes, type- -=--:---------- i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, mb st be placed on reverse side.) NEW INSTALLATION' (No s2ptic tan or seepag6"'pit 'perm;tied if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK' ` } : ., - - --------------- -Liquid Depth._--------------- . . . . � - w 1 Capacity-1_/ ( �- sType -,�--------- Material. _ No. Com t ! T ;---i -- rtmen s c ppa 3 Distance to nearest: Well ;, , • { a -- :Faundativn.. ._.: = Prop. Line--------= LEACHING LINE: t ---- . ... ... ...:..:....Length of each line;_ t ' - �. Depth �Q._: Total Length._.`( -Q; # 1 D' Box____._-__ Type Filter Material__ [ ] a( _ p .. Material f- .1. ------- ------ -- - - ----- - " Distanca: nearest: Well--- } E p to Weare �Foundation_____._ Property Line______-_ ,. .. PIT , .p .. .._.. . . ..:..�... ::_-_ ---------------------- SEEPAGE f [ ] De th__ jd_: D;iameter ---Number---_- --- i- _ t - : Roc Ye No`❑ , Water 7a�le'.Depth.__=_____ -i Rock Size-----r� Filled s I! i Distance".to nearest; Well ----__-- Foundation IProp. Lane I REPAIR/ADDITION (Prev.:-Sanitation-Permit*-, i ' ------- Date Septic Tank (Specify Requirements).:--_-__._...:_.__.:__---__ ------------------- Disposal Field (Specify Requirements)______ ___________ ------------- --------------------- ---------- ------------- ----------- - ---------------- ______ (Draw existing and required addition on reverse side) r I hereby certify that:l 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 ageizts signature certifies the following: : "I certify that in the perforrnance'of',the work'for which this permit is issued, I shall not"em to an to become subject to. Workman's Compensaticin�laws..of California." P y Y person in such manner as Signed--------' ' - ___-___--+.___._ _ _ i Title }-------- (If other than .owner) w ----r..---r -- -- ---:-_= - . - FOR DEPART ENT USE'ONLY - APPLICATION ACCEPTED. BY ------ ------ ---- ----------- -- _.------:- DATE. -7 ------- DIVISION OF LAND NU -- _.--___ _ __ _ ______________ ADDITIONAL COMMENTS- -- DATE_.----------- -- - ------ -Y.- ;�_( ----------------------------- �a - ----------- = = ----- ------------ ------------------ ---- --------- --- Final Inspection•by:_-.__-.=-_- _ }- . _ - - � - ----•------•------------- ---------- : -------- it " ,��. Date/. --Z3 _ _ _ „___� . _' EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fes 21677 REV. 7/76 3M pp J