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FOR OFFICE USE: f FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT 0 -- -- ----------------------- --------------------------------- (Complete in Triplicate) Permit No.�7----��--? t ------- Date Issuedl-1" --- 77 y This Permit Expires 1 Year From Date Issued ------------ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. compliance with County Ordinance No. 549 and existing Rule Regulations-. This application is made in .. _ j ' -CENSUS TRACT------------- ------------------ ------------ • I - = --------------- - -- JOB ADDRESS/LOCATION G------------------------ - s S` .. . _ ' - Phone- Owner's Name._.. �_ - - ' - -- ------- ------ - --Cit - �ip- - .f ---- - � - y Address_. � -� : ' i License #__ Contractor's Name-_-- -- � = - ------ F Phone. lnstallation will-serve: Residence [' Apartment House[] Commercial ❑ Trailer Court. ❑ n : Motel El' Other --------- i s y - -------- Nu �a Number of living units:______�_.______Number of bedrooms....,_______Garbage Grinder--- :- of 1ze- = - _ Private Water Supply: Public System and name------:.------------------`------ -------- ----------------- 4 1 ❑ y Peat Sand Loam Clay Loam ❑ depth of 3 feet:/ Sand ❑ Silt Clay ❑ ❑ Y ❑ y i Character of soil to a de Hardpan Adobe ❑ Fill Material------------If yes, type-----------------:------ --'--- 1. p , p I (Plot plan, showing size of lot, location of system in relation to-wells, buildings, etc. must be placed on reverse side.) f NEW INSTALLATION: (No septic'tank or' seepage pit permitted if public sewer is available within 200 feet,) C i PACKAGE TREATMENT [ ] SEPTIC TAMC [ -Size:-- --==X.- -!" e-----5�-------------------Liquid Depth----- .--------------- .;. �_ T e ----=---- - "'----� Material----'--- -- --�-�--.._No. Compartments-- -��--- ------=- � Capacity `: Yp �Gam - .1 r ,..J. ... Distance,ta riearest:.We{I.--'---°=---` --- -•-- - Foundation= tt-b-=-------------Prop. Line..-•- -------- LEACHING LINE ., [tJ _ No. of Lines :_ -- _--.Length of each line-------.__.�-,� � '-_---•Total Length. _.. .-a r✓---- S h Filter Material.____1- -"�_ -- ---`- -- Box..._ f. TYPe Filter Material-,-_- �� Dept f - r / .- . ., `Ufv� y`,,' Foundation U _ Property Line Distanceto nearest: Well h � y �.-. (k FillecVYes.[�No ❑ ,/ '-'��-- : Roc A SEEPAGE PIT [ 4/,Depth.-.-r2-r2 `�_ Diameter -- - ----.Number_ f �;:f Water Table Depth---:____. -- - = '`-------.Rock•Size. ._f � . x 3 y + I b:1 b ---------- --------.Foundation------ -{-'C7--- ---..Prop. Lin e- - --"-----'------------- i ;Distonceao nearest: Well-.'____.___-----___--- . ",I . . --_ � ---------------------------------------------- - --- --------- --=------ Date-- ----'�---_ ---------- - ---- } REPAIR/ADDITION {Preva Sanitation Permit#_.-._--_..___-_--__: Septic Tank (Specify•Requirements)---------------------------------- - ------------ ------- C�/ _._____ t.-___----'-��-,�f----------------------------------------- --f ' Disposal Field (Specify Requirements)--=---- ---------- - - --------------"-------------------' y I ------------------------------------------ ---------------- ---- ------------- --------- ------ _ . , (. r ---------- -- ----------- (Draw existing 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. Home owner or licensed agents signature certifies the following: 111 certify that in the performance of!.the work for which this permit is,issued, l shall not employ any person in such manner as to become subject to..Workman's Compensation.,laws of lifornia." ter_ k _ Signed_ , Owner - s` j -tie 4 f---------------------------------- -- -------- BY , (1f other than owner) �43 a Ilk k FOR'DEPARTMENT-USE,O LY APPLICATION ACCEPTED BY �ill - DATE TE -------.--------------- - ---- DIVISION OF LAND NUMBER-----------------' - ---------------- 1 ADDITIONAL COMMENTS-__.-:------------------------------------------------ ---------`- ------- 6 9 , _ __-_____ __________ _________________________ _------------ __ . __----___r_ - «✓ to _. = Da Final Inspection by: --- _- - " - " - ----- ----- - - .. ,. -f&5 21677 REV.7/76 3M EH 13 24 SAN JOAQUIN LOCAL"wI=ACTH fli�rRICT ' ---- -