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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No.._-.-7--j--- --- (Cin Triplicate) Mle �A Date Issued--- --------------------- y ------ ------- _---- This Permit Expires 1 Year From Date Issue ' � a Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. N +� i g Rules and Regulations: _ n c bnce¢with:County Ordinance No. 549 and existing � _ This application a made In com lia � _ . P -,-.-.CENSUS TRACT.--- -------------- G+-------------------------- JOB ADDRESS/LOCATION qw? � --Phone. wx Owner's Name..--------- ------- { -- -- -- -- ---- Address----------------- G �P F . ---- L'cense Zip - -- - - -- ane - ------- ------------ --?- -� #� Ph f Contractor's Name--------------- ----- ;: , Installation will serve: _ r Res+den"ce Apartment House.❑ Commercial ❑ Trailer Court E] f �. ' .Motel;❑; (-O&r _--_Garba. a Grinder_.--_----=_Lot Size------ ----- Number (--Num ber of living units:.--- --------Number of..bedrooms__.. g } =_ - -------- --- -------------------------------- mePreva i Sand L Water Supply: Public�ystem and ria _.__ :--- ,------:'--------._ Private . ' Silt: Cla Peat ❑ y Loam ❑ 1 Clay Loam ❑ Character of soil. to a depth of 3 feet: Sand ❑ , 0 Y 0 _ .. ti--.F Adobe ❑ Fi.11 �llateriaL-.--< If Yes,type Hardpan ❑ (Plot plan, showing size of lot, location of system in relation to^wells, buildings,'etc.;must be placed on reverse side.) 4 NEW INSTALLATION: (No:'septiE tank"or seepage pit perm ,l itted if public sewer is available within 200 feet S_ - - =-------------------Liquid Depth._� ----------- PACKAGE TREATMENT [`�J "SEPTIC TANK"" Size____-.,__________ �. - Material_-. '----No. Compartments------ Ca acit ��( _--------TYPe._.g - ; i P Y` Foundation--'- l Pr Prop. Line_:-��-7`- ..�L,.Dista�n a to nearest:.Well- --.---- ------------------------ fi wA LEACHING LINE Ro ---._Length.of each line.,.::_-. �. .: r .Total Length. -----� -ri ----------------------------------------- 'D'�$oz_- L�Type Filter Material: --Depth Filter Ma,enal. '- �� --- _ :.. ' r Distance to nearest:Well.__-_tom ------- Foundation-_-!�_C� --- ---- PropertyR k Filled Yes No ❑t �/ 'Depth —. SEEPAGE PIT `1`) Depth-_�------Diameter'¢ %- 3 ' Number = = i - -.Rock Size , --- Water Table':Depth---------- ---- Y, ;-::v� �. b -t Pro Line 73 --------- - i .Foundation----- --r------- --- P- (Prev. istance.to nearest: Well.`- ------ ---------- 1 = REPAIR/ADDITION Sanitation Permit-#-- -- -- -- -.Date_. : :_- - } --- -------- ---------------- -------------- Septic Tank (Specify Requirements __ ---------------- 1 Disposal Field (Specify Requirements)._-_---------------'--- - - --------------------- n , _ -` ------ r ---- - ----- - r f`` -----------•- --- - = ---------------------- = - existing ani requiredad"difiionrti oreverse side (Draw } I hereby certify that { have prepared this application and that the 'work will I be done in accordance with San Joaquin County tions of the- San Joaquin Local Health District. Home owner or (licensed agents Ordinances, State Laws, and Rules and Regula signature certifies the following: t "I certify that in the performance of.the work for-which this permit is issued, �1 shall not employ any person in such manner as to become subject to .Workman's ..Compensation- laws of California." �: s -.----Owner y1 ;. i- '�� fi Signed-_- - --- ------ "t Titlee---- '' _ ---- ----------------- T s (If er than.owner) i -FOR DEPARTMENT USE ONLY' n i -=- DATE _.----- - - APPLICATION ACCEPTED BY-------- -- - - ------------------------- DATE-_----------------------- - ---- ------ ------- ------- -- ------ ------- ------ ----- ---- - DIVISION OF LAND NUMBER --- --- --- - - __---_ ADDITIONAL COMMENTS------------------------� --. �r� ------------------ ------------------------ --- --------- -- 1S - g-� ------ ----- ------------- --------- Date ---------- -------------------------------- ---------------- - Final Inspection by: . ....-.�--- -- k-L F&5 21 677 REV. 7/76 3M EH 13 24 SAN'JOAQUIN LOCAL HEALTH DISTRICT