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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --- ------- --------------------------------------- --- Permit {Complete in Triplicate} p �� I Date r ----------------- This Permit Expires 1 Year From Date Issued F Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. I This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: T -� ,�. •,rte. _ .- : -- -- - Q��-- JOB ADDRESS/LOC N U B �.`---tq�-3`e2s ----------- .CENSUS TRACT �_� f Owners Name...... l- F --------------------- ---------- - ----- ---------------------------------- Phone.._ S•' ---- ----------------- Ad - ------------- Address 1 - r � ------------------------------------------- 29 # Cit -- -- 7 � 5 Zi - F License # c1 Ph Contractor's Name_____. __ � _-- ___ one---------------------------- Installation _____ ___ _ -- Installation will serve: J Residence Apartment House ❑ .Commercial ❑ Trailer Court ❑ `' Motel Other- ----------------- -------- _.;. .. . Number of livin units:._£__..__1_____Number of bedre� rrls_'.__._ _Garb ` ' f g age Gr.inder._--'.-.:.`_Lot_.Size------_-- T-- Water Supply: Public System.and name-------------------------------'{---------------------------------------------. - -- __ i ----Private y Character of soil to a deptk�-of 3 feet:. Sand E] Silt El ?Clay ❑ Peat❑ Sandy Loam.❑ Clay Loam ❑ ; t { Hard part Adobe:❑ Fill Material-._.._.....If yes, type, -,f,-- g--------------- {plot plan, showing size-of lot, location of system in relation to wells, buildings, etc..m st beliplaced on reverse side.] NEW INSTALLATION: {No septic tank`or seepage*pit-permif'fedif puljlic sewer is available within 200 feet,} PACKAGE TREATMENT r[ ]` SEPTIC TANK [ j ize._'-__.______r_r ____________ �_fokl��__K�Liquid'Depth.-___�_:_� __..__t___ 4. .. Capacity__1:_2CJ0-...Type--P C°l Mater ial___...... �Z" No. Compartments_=-------2- ------------ t- _ Distdnce.to nearest: Well-- -A , - ----- I---- ---- Foundation 1Q---------�____Prop. Line---- -� _---------------Q i s / 7�? LEACHING LINE [ ] ' No.-of Lines ' L ngth of each line______________ __________ ___Total Length ----------------------------------------- D' _ . .,_Z_--C}r _ ,� �_-k_ z-____-De Depth Filter Material-___ _- ' D' Box-'_-�------Type Filter Material �'� p _��y_ __-- _ '_____ ___ _ ____- '----------- :Distance -- ;_-. Distance to . . .� .._ ;,. � t riearest: Well_______ - �----------Foundation___'-----------._ __ ____;__-Property Line._--____fir____ _________-__- r SEEPAGE PIT [ ] Depth D}meter.__ Number Y i _; E^Rock Filled -Yes ❑ No❑ �f - Water Table f Depth.. - --- - -----------------------------.---Rock �Size---------------------------T =- ---- ---- - ' � � 1. � � l�. . :.... � � ° on--=-------------=---------Prop. Line -------------- REPAIR/ADDITION - REPAIR/ADDITION Prev:Sanitation Permit#------- --_ J ---.------'Date- ----------Foundation -- M Distance<to nearest: We ' • Septic Tank {Specify'Requirer Tents)- .- ----- - --------- ----- --- ---------------------------------------------- Disposal ------------ --------------------------- 1 � .. = t Disposal Field (Specify.Require_mentsl; !t :: ----- -------------------------- 1----------- ----------------------------- - p # r x7 } � ►i _ ____ ____.____.__ - -------- ---_------:- _ -_________. -_____"_______ __"____"____ __________________ ___________< I t (Driaw existing and required addition on reverse side) •• t I hereby certify that:l have p�repared thislapplication 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 agents signature certifies the following: "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." I I Signed - :------ --- - � - ----- - '_ __ Ownar Ti (If other than.owner) l� f FO D AR � ENT-USE ONLY .... s.. _..r.. r I r k APPLICATION ACCEPTED BY - - - --------- = ------ �`�"---------- - --------------- ---DATE T f DIVISION OF LANA NUMBER- - DATE_-- ---- --------- _. i ADDITIONAL COMMENTS--- -1---------------'.--------- -------------= ------- ------ --------------------------------------------- ' ----------------------------- ----------------------------------__________ ______________________________________________ _____-_-_-____ - - _ --___:-_-__-_______________--_.______-__________-____--___-_-.______ _•-_-- ___________________________________________ __ _ a __-_____.____._________._ - --_------------- -------------------- Final - _-- _______-.__.Final Inspection bY ---------�— -- ---------- v '//-'-17----=------------------- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M