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. R r- FOR OFFICE USE: `FOR7OFFICE USE: APPLICATION FOR SANITATION PERMIT -------- -------------------- Permit No.- " ' .-0-5_ ---------- "-------� ---- {Complete in Triplicate} ' ------------:----------- Date Issued-.5�-3�"-7f This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health�D.istrictjo�r.-,ap ri� .. nit to`e onstruct and install the work herein described. This application.is-mallein comh C pliance witounty Ordinance No. 549 and existing Rules and Regulations: --,�--- JOB'ADDRE55%LO TION' CENSUS TRACT---------------------- ----- 1 - —---_--- ------------- -----= ' Phone 2 ------ ----------- --- Owner's Name.NN --1 6 °` ------- Address_/_Y��-: ' it R C Z i !_ � L.'i ens # _ Phone---------------------------------- Contractor's Name_- ----- - . c e ❑4 4. -- Installation will serve: + Residence /Apartment House❑ Commercial Tra1(er'Court ❑ Motel ❑ Other } ---------- e Number of living units:."�_-- Number of.bedrooms9":___.Garbdge GrinderF._..__ _lot Size____.:._.._.__-_--- Priv - - -------------------------------- Water Supply: Public System and name-----------=---------------------------------. 'n_____Loa CI Loa ❑ Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ . Peat ❑ Sandy m ❑ ay m # { Hardpan ❑ Adobe;❑ i 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.) {w W INSTALLATION:- .(No septic tank ;or seepage pit permitted if public sewer is available within 200 feet,) `1 PACKAGE TREATMENT . t� , ..,. t - 'Li uid Depth `i l SEPTI�TANK� Size - q P'CapacitY- ype- Material _._ ' NW Compartments--------- -- d f - -------- r Lin -- ---------- Distance to nearest: Well-=- ��______________ ---- Foundation !- Prop. Len Y _ e • _ t - Length._ - -- No. of Lines------------ h line Total Le g - LEACHING LINE �( .1.;� �A -""� "�-- Filter Matenal_.�•d f� � " 'D' Box Type Filter MateriaLt Depth - .,. . �Y ---- ------ ------ -------- - `` Distance;to nearest: Well.;--------------------------Foundation__ ,Proper#y Line __ I eel --Number--------------------------------- Roc --=------ ----- ------- ------- r Rock Filled es ❑ No❑ SEEPAGE PIT [-'l� t • ,P F Y De th----:..--- � Diameter --- --------- iz ---- ---- ----- ----- f Water Table Depth_ ;-. Rock S' e_ .._ _Fouhdatian Prop, Line ' Di'tahce to nearest.Well ---------------------------- ----------------- . ' REPAIR/ADDITION (Prev. Sanitation Permit#___ __. ---_ "--- --- r=--- --Date._--.-._.. -_. _- ) i ; = -' ---- ---------------- Septic Tank (Specify.Requirements) = € r ---- -------- ! Disposal Field (Specify Requirements)_ - 1 --- i -- - -- ------------------------. --. --: --- � - - .-:--- -- y l - - --------- - ----------- ------------- a -------g----------- ' 3 ----- ---------- - -,,-- r i -;_ _ ., g ' Draw existin and required addition on reverse side) I hereby certify that 1 have prepared ,this application and that the work will. be donein accordance with San Joaquin County Ordinances,. State Laws, and Rules and Regulations of the:, San Joaquin Local Health District. Home owner or.licensed agents j signature certifies the following: l I "l certify that in the performanie of,the work'for which this permit is issued, I shall not employ any person in such manner;as to become subiect to orkrn 's Compensation; laws of California." _:Gvt -- -------------- `----- --- -' ------------ Signedr _ f .. . . ,. __ By- t Title " -------------------- --------------- - - ----- ilf'other than owner) , FOR-DEPARTMENT USE ONLY !' APPLICATION ACCEPTED BY _ ".-- - -- --- DATE. �" = 'i ----------------------- DATE-------- --------------------- - - ------------- -------------:� � I DIVISION OF LAND NUMBER� _J - DATE---- - ---------- --------- - - -_---- ._. DIVISION OF LAND NUMBER ------------ - ------ ...._ -- - I ADDITIONAL COMMENTS----' ------ ------ ------- -------------------- --------------- ----------- "------------------------ ---- - - - -- ------- Da Final-Ins ection"b F&S 21677 REV. 7/76 3M EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT