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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No..�-- �� y ----------- (Complete in Triplicate) ---- - ----- - 4 ----- Date Issued--S=--- --- - -- This-Permit Eiipires 1 Year FromrDate Issued uin Local Health District for a permit to constrs and and 'install the work herein described. Application is hereby made to the San---- Joaquin Ordinance No. 549 and existing Rule r Y G This app Y CENSUS TRACT -'--- ` r lication is made m com (lance with Caunt r t - - p ... = LOC TION - Q. . JOB ADDRESS/ Phoney, . i -.. / 7 - ...... .-- ----- Owner's Name.= City. y _ Zip' / + 11 -- ---- - - S r v� ---- ----------------------- - _- _ O Phone._ ---------------- ---------- Address #- - ---- -- -- Contractor's Name- ;- -- -- = Commercial ❑ 'Trailer •C-ourt�❑ + ' Residence Apartment House ❑ l 1 Installation will serve: : ❑ Other_ u ' 'Mote l �/ Nii... -. l of,Si ' t n ooms_ _ e Gri der__--- - -=-L ze_ rf ___Number of be'dr ----Garbag, Numbei of living units:_ J _ Priv - �- - Qte '❑�� Water Supply:.Public'System and name-.-__-- - t= Peat Sandy Loam ❑ Cray Loa ❑ k [Silt ,Clay ❑ �.. _.�. Character of soil to a depth of 3 feet: Sand Q ` - '• Fill Material------------ es, type__ ---- ---- --- -- --- i = Hardpan ❑ , Adobe it Y a: size of lot, location of system in relation to wells, buildings, etc. must be placed h°n reverse feetside.l". � #� F e (Plot plan, showing s it ermitted if public sewer is Oval M NEW INSTALLATION.- (No septic.tank or seepage p p -t ., - -'----Liquid Depth,_._---.--- �� SEPTIC TANK PI - - Size - --:- ----------� - - -.. , PACKAGE TREATMENT [ + Material _ _- -- _No. Compartments--------- ---------- --- - --- t '- O 'Type r Capacity J .to nearest-,-Well = = Foundation = ' `-Prop.�Line -- t - ' g - Len th of each line- i € - Total: Len th � '. No. of Lines,,--.--------:_. , t LEACHING LINE L ] G .� -.,.�,y.. .'. ... D' Box. Type Filter Materia! -------------------- ::- - --_"- __Depfih F I - filter Materia E i ___ _.Foundation -- _ -Property Line_.-- -------- Distance to nearest: Well----------------- - Rock Filled Yes C1 Number-- -- = r, Roc � . Depth--i-- ----Diameter ------- SEEPAGE PIT [ ] °. 1z Rock S e ' f Water Table Depth - Pr ine------------------- Distance to nearest: Well---------------= ' Foundafiion----------------- - op_ L Date. = _._ " REPAIR/ADDITION (Prev. Sanitation Permit 1 #--'.--- ----- _ �� e -- ----------- = = (Specify Requirerentsi__----_--- .- ---- Septic Tank (Sp Y ---- --' . -�-"` ---- - J.J Dispos I Field (Specify Requirementsi_------ -- - ----------------------------------------------- .- ------ �f G ----------------- ------------------------ f Pc S r' 6�= — -- I --- ------------ ----- ------------------------------------------ E - (Draw existing and required addition on reverse si e I hereby certify that I 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 agents signature certifies the following: l certify that iii the performance�of'theework for which this permit is�issued, I shall not-employ any person in such manner as to become. s ct to Wor n's pTpensallon:favus of California. rCoy- Owner Signed_-.. - e Title__ f BY ----- k (!f other than owner) " FOR DEPARTMENT USE ONLY DATE.--��--�. �- --�-- - -- APPLICATION ACCEPTED. BY_ ------ -- -- DATE ------------------ ADDITIONAL COMMENTS--------------- ------ --------------------- DIVISION OF LAND NUMBER: = ---------------- ------ ADDITIONAL -- ------------------------- ----------- -------- ---- . �----.��------------- -------------- --- ----, -----: .::: -{ ---- ------- -- -- -- -- - -- -� --- - - -- ----: -- -- ---- - - --- - -11 - ---- F&5 677 V. 7/76 Final Ins ecti n by: _ EH i3 24 A JOAQUIN LOCAL HEA H DISTRICT /1, / kiln.+-c/'�