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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit Nod--7q s�0 ------. (Complete in Triplicate) --------------------------------------------- I r, �.. � Date Issued-_f��I{-/-7-T- , --------------------------------------------------------- ---------------------- .� This Permit Expires l 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. Apphc _ I This application is made in compliance with County Ordinance Na. 549 and existing Rules and Regulations: - ` ' s GENS US TRACT ------ ..- ---- JOB ADDRESS/LOCATIC f Phone. = _ ----- ---------- Y - [ -------- Owner's Name------ �- e- _Cit ----Zi • -.-�- -� Address--------------�-: f--F- � o ----- ---- ----- -- - �--- i �t— e- ak ----License # $ ! Contractor's Name_._ - ---------- A Apartment House-El �Comme �ial ❑ Trailer Court ❑ installation will serve: Residence ❑ P 11 Motel ❑ Other_'.YYt., . -- [ _ �-+ Number of bedrooms-. --Garbage Grinder-:_- - Lot Sze;rn Number of living units:- -_. Private [ - Water Supply: Public System and name- . . - Clay Loam ❑ f Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑` ^ Peat ❑ Sandy Loam ❑ Y + Hardpan Z Adobe❑ Fill Material.,-, if Yes,tYPe------------------------- ------ Plot Ian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.} ( P ' it permitted if publ'+c sewer is available within 200 feet,) NEW INSTALLATION: -(No, septic tank or seepage p' p A �/ �r d ,w Liquid Depth._- At— I! PACKAGE TREATMENT [ ) r.SEPTIC TANK [>� ' E ! - .. 6 4 A e: Material �•'�'`''`�" Na. Compartments--- capacity-144-10 ompartments-- 0`! Capacity �� TTP ------ ------Foundation =----41 ------en-prop': Line-. Distance to nearest: Well.- t _ _ Total.Length :�- LEACHING LINE [� No. of Lines;;_-- ------- ------ Length of each line..-- �?-,----_:- it 'D' Box-__-�_-..-.Type Filter Material:;-_,�--� -- Depth Filter Material ------- � `� Foundation �. ---------.Property - Linie------ -J J P �v ; Distance to nearest: Well........ Rock Filled Yes / N sa SEEPAGE PIT [ Depth--�`_� _ Number = Diameter- ----- j Water Table Depth ------------ Rock Size__.- Distance to nearest:'Well -d--- --------------------Foundation-------�1-------------- Prop. Line-------------- ' Date----- -------------- -- ---------------------•-- } REPAIR/ADDITION (Prev, Sanitation Permit --__------_-- - -- --------------------- Septic Tank (Specify Requirements :___-----_-_--------- ----------------------- Disposal Field (Specify Requirements):----------_------__ - _ ----.--- -- ------ ----------------------- ------------------ ---------------- - - ---------- --------------------------------- ---------------------- _ ------ ----- - -- --------------------- --- -------------------- - (Draw existing and required addition on reverse side) Counon oaqui I hereby certify that I have prepared this application and that the work lLo al Health Dist ictt. Home e done in accordance wi th ser J oorc licensed agents Ordinances, State Laws, and Rules and Regulations of the San Joaquin r signature certifies the following: 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as " 4 to become subject to Workman's Compensation laws of California." ' - � -- --Owner .Signed------------------------------ e " --------------- -------------------- Title---- By ----- Title.-- $Y � ------------------ (If other than owner) l FOR DEPARTMENTALISE ONLY DATE.-------------- ----- -- i APPLICATION ACCEPTED BY----------------- ------------------- --------- ----------------------------------- - - ------ DATE.---- ;°.----- ----- - ------ DIVISION OF LAND NUMBER--------------=--- ------------------------ - i ADDITIONAL COMMENTS---------------- ------ - --------------------- -------------- ----- ----- -------------------------------------------------- --- - ---------------------------------------- --------------------- i� � -- --- --- - - -- ----------------------------------------------- ---- -- ---------- -------------------------- _ Date '' Final Inspection by:-._--- -- F&5 21677 REV, 7/76 3! EN 13 24 SAN J UIN LOCAL HEALTH DISTRICT