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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No..........- A///.... 96-/-�f Date Issued.. ............................... - . .------------ i_A This Permit Expires i Year From Date Issued s Application is hereby made to.the San Joaquin Local-Heal h District for a{permit to construct and install the work herein described. . This application is made in compliance with County Or ance No. 5 and existing R sand-Regulations; _. I JOB ADDRESS/LOCATION-f_: . r... ... CENSUS Tt2ACT________-•-•-- ......- Owner's Name.... ... �I I -•-•--• -- . . ..........--................................ ----------Phone.......... ..............-............. Address.......- ------------ -----------1-1 ..............Zip................... . I J. Contractor's Name....... � License #... .Q. ! - / 7 ► II, .. -Phone-9> Installation will serve: � "Residence -•- -- - -� • I, Apartment House (J Commercial ❑ Trailer Court [j I `Mote! ❑ Other......... .....`......------ - - - ---- -- II Number of living units-------- Nurrlber of bedrooms...0'-..,.Garbage Grinder.-..____---lot Size.....-�-_- II - - Water Supply: Public System ond.name-. ----- - - - -4 vete ❑ II. .................:......... ........ .....................•------------•--- ------------- -•--................Pri r Character of sail to a depth of 3 feet; Sand04 -Silt[] Clay L] Pearn Sandy Loam❑ Clay Loam; r Hardpan L] Adobe Fill Material . .... ---.if es, type_ Y Yp .-.................. ------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side_.) NEW INSTALLATION: (No septic -tank or- seepage pit permitted.if public sewer is available within 200 feet,J t PACKAGE TREATMENT ( ] SEPTIC TANK [� l Size........ . Id.. ----------------- -Li Capacity,/Ib_kp_...._-.-.Typ ....Material.. -f'i'b" ..--------No. Compartments- --L............ ... a t If Distance'to nearest: Well.-- �� ..... .....:.:.. .. Foundation �d. .........Prop. line...�.... ----------- LEACHING LINE No, of Lines .......... ... ti f t � III � ----....----length of each line . •- ��-..........�.:Total Length `"-:.J�O•.- -------------------- 'D' -- --- - D' Box.:i -Type Filter Material.. �c -.--- .Depth Filter Material,, � .. ... ........... .........-------- . Distance:I to nearest: Well...�? ------ -- Foundation.../g?-------------------Property Line ----------------------- p T De th----EJte'�. I -LLNU _.=•z._. ..:.:..: .. Rock Filled- Yes No Water Tonle Depth. ---------- - - ... . ....Rock Size—'A"P---. . .--------------- I Distanc& o nearest: Weil-----/a49 .--........----..-.Foundation -- -1p------------ -Prop. Line.....--........- REPAIR/ADDITION (Prev. Sanitation Permit#............ .., -----------..--Date- - ----..-- Septic Tank (Specify Requirementls ------------- l- Ili Disposal Field (Specify Requirements). --- - ---- ... --i` - ------- -- ------........................... . .--.......- ..........--................. ------------------ `" =1 •• --- ------ ----- .. .-- - ------- ------------- ------------------------------------- III (Draw xisting and required addition on reverse side) 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. Horne owner or licensed agents j signature certifies the following: F "I certify that in the performanc e of the work for which this permit is issued, I shall not employ an person in such manner as P Y Y P to become subject to Workmanl;s Compensation laws of California." Signed---- .... A ............:. caner -- O ay. ................ . .... ------ -- ----------------------r...... It .............. . ....................................... llf other than owner) 'If FOR DEPARTMENT USE ONLY' APPLICATION ACCEPTED BY.----- •-----_-----__----__TT____-_ .................................................... ..• .....DATE ... .�.�..`�..+ ................ DIVISION OF LAND NUMBER .. t ------ -----ADDITIONAL E- ADDITIONAL COMMENTS- ------- Ili......... ----------------- Ii _--- --- ---------------.---................... ..--............................................................... .-.-.... - ---------....................___....------------ .I - . --------------- _-•-- •-•• ----------- . ........................ .......................... ----- ...-.---- -- --- ------ Final InsP -ectlon b � s. .-r -- -Date. --.-,2--'-A ..... ................. ..... EFS 13 24 -III SAN JOAQUIN LOCAL HEALTH DISTRICT res 21627 REV. 7/76 3M