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FOR OFFICE USE: FOR OFFICE USE: --------•- --...._.-- APPLICATION FOQ SANITATION PERMIT !11 (Complete in Triplicate) Permit No•.�9:__�:�—r._ .......................... . .... .... � ...•....... This Permit Expires 1 Year From Date Issued Date Issued. I Application is hereby made to_the San Joaquin Local Health District for a permit to construct and.install the work herein describe This application is made.in.compliance.with County Ordinance No. 549 and existing Rules and Regulations; � JOB ADDRESS/LOCATION..__`- -7. _....._./Ua>" 7 ---L/.,.__/�<ON' Fj Com/ sTi(��V.............CENSUS TRACT...--------------- .-------.. ' Owner's Name ._ . ;.!.. d/! �i(�---=--- `y — .. Phone.-9.. l----`3Q-17'(J.-- Address--.......5Y' .% .. / IOd'��'� Cit SVel<7-p Zi 15 .1. Y --- p = Contractor's Name._. - ------------- ------ --•---... ........License _:-.._T.....Phone---- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑`, Number of living -units:... 7Number-of bedrooms-:3-- Garbage-Grinder__.----.- L-of�Size--,- - Water Supply: Public System and name.. ... ........"------:---------..- ....._...tf------ ----------------.------:-X - Private Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ -Clay Ej Peat El Sandy Loam ❑ Clay-Loam ❑ k Hardpan Adobe. Fill Material.. _ _. ' If yes, t e-.�- (Plot plan, showing size of lot, Ioca-fion of/system in relation to wells, buil�jngs, et\must be plac'ed .on reverse side.) NEW INSTALLATION: (No 'Septic tank or ?seepage pit permitted if public sewer is vailable within 200 feet,} ` PACKAGE TREATMENT [ ] SEPTIC TANK, Size- ---�'`'- --------------------------------------.-_'-- _'Liquid De th...---•.------... �! r + 7 EX/ST/fib Capacity.... ' TYPe �"` . Material-...........................No. C partn132 t19 . =--•-------- I Distance to Barest: 1Nell_n....--...-_---`..: ..`` " --..Foundation ..,.PProp. Line........................... I LEACHING LINE [ J No. of L'ines' sr;-._-:-_-. _ Len th of.each line._..__..._____._._ ' - g -------..__Total Length .�-:,-��--�•........................... &)(1ST1rf/C-- D''Box --. ......Type F �ter•IUlaterial _ ..." Depth_Fil.ter_Materi.al., .... ---------------=-------------------..----•-.-....---. Distance to nearest: Wei 1--5............ . .'' .'F.oundation---------:..................Property,Line--------....._ .. -.... SEEPAGE PIT [ ] De 'th._..---_ ` Diameter--------------.-._.Number--------------------_ _ _`--. Rork Filled Yes E Na Y Water Table Dept -� - Rock ...- . -------- ----:--•.•----._...... Distance to nearest: Well--. , ; .......... ......Foundation.........................,Prop. Line-------- ---- -- ------- REPAIR/ADDITION -----REPAIR/ADDITION (Prev. Sanitation Permit#------ h-5: : .._.:.`.. ---_Date--- -------------- Septic -------------Se tic Tank jSpecify Require men�_ts)... .... Disposal_Field (Specify Requirements)_! .--- ------------ a_�----/j�1----1(. ._.__ �_TS----770._.EX��2'T� _._. .....•__________________ ____________________ ................... -: -..._.__.!__.._.._..........___._._._..._---... ._-._...._..__--............_._____... F I JDrow existing and required addition on reverse side) i 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 ane! 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, 1 shall not employ any person in such manner as to become subiec to Workman's Compensation laws of California." . Signed--- ..-- . . ............ Owner BY L"� . �Q/1'�olpa -............ Title_.---------- -ST/.Cn7��.. (If other than owner) F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- 41' ----• �- .._.-----DATE ...-.- -. -- II..7....................... f y DIVISION OF LAND NUMBER.............. ..-DATE----------------- .. ADDITIONAL COMMENTS........... ... - _-1q:_ at9 .. ,.. --_-- .......... ---------- .-- :.... ... :.:..: ------- Final Inspecnan by:....._ .__ . Date....S---W-1_ - EH 13 24 ,, SAN JOAQUIN LOCAL HEALTH DISTRICT Fes 214,77 REV. 7/75 3M