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OFFICE USE: FOR OFFICE USE: I APPLICATION FOR SANITATION PERMIT ,, 77 (Complete in Triplicate) Permit�No.__�_f.^_-- - - -- ----------------- This Permit Expires 1 Year From Date Issued Date Issued_/l'-�`7?. --••------------------------- - i Application is hereby made to the San Joaquin Local Health District fora ermit.fo_cons ruct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: l pper.-. . --' ar0 ( CEN5US TRACT JOB ADDRESS/LOCATION------- - ner's Name. !_3. -t4 Il------i 7 a` �LJ�'✓Z. -esL----------------- Address �f ----- Phone �= + Address b Lci ------ -`------ -!✓- Cit �-- Contractor's Name_. A,C_ __:.__ D '�1 -- d� :_License_#.: -0 -3_ ___Phoneczz �s Installation will. serve: Residence ❑1 Apartment House.❑ Commercial ❑ Trailer Court'0 s �• Motel-[j- Other---'.L............. .----- -.. Number of living units_____ ------- Number of,bedrocom;s.____.:'____Garbage G�inde�r-�- __Lot Size___._._��._�r�______.._._._.___.____�__._. Water Supply: Public System and name - '' ! _ - �� f �? `` _ private pp Y ---= .__ Character of soil to a depthhof 3 feet: Sand—X Silt k 'Cl"y�] :--Peat❑ Sandy Loam E] .� Clay Loam E] Hardpan ❑ Adobe ❑' 'iFiil Materia l____. __.___If yes, type__-_._____.T'-_----- ,a..__. � tt -,i (Plot pian, showing size of lot, location of system in relation-Jo wells buildings, etc.'must be placed on reverse side.) p ' NEW INSTALLATION: (No septic tank,or -seepage 'pit permitted_ if public sewer is available within 200 feet,) PACKAGE TREATMENT ['] ' SEPTIC TANK ` `----- � ---Liquid-'Depth.___.____---._______ [ 1 .� Size---=--_--``"=�---------------------------- - Capacity '=;TY e. _- ._s Material----------------- --------No. Compartments------------------------------- Distance;to nearest: Well--° ------------------ . _ --------_Foundation_..-------------------------Prop, Line------ [.] No. of Lines--------------- ---- -3- g ----------..Total Length.z--- t i LEACHING LINE .Len Length of each line-----------------=- ----.-----_--_--- ---- I D' Box- --- -Type Filter Material------------- -----Depth Filter Material-_____-_---_ ' Distance tornearest: Well------------------------ --Foundation---------,------------ ^. SEEPAGE PIT [ ] De * ._Diameter_._____.-_-_:__-.Number--- - -_---._______________ 'Rock Filled Yes ❑ No❑oD Water Table Depth-----------------=---------------------------------- --Rock Size--------------------- ---------------------- Distance.to nearest: Well.-----------------------------•--------foundation-----------------------`---Prop. Line---------------------------- REPAIR/ADDITION.JPrev. -.---REPAIR/ADDITION.{Prev. Son itation�Permit#-------------------------------------------7� .Date.---------------------- ----i-e........... ) -z Septic Tank (Specify Requirements)----14.0-0'5 -c_.--------�`o--------4_ ;----- --`-- Wi t$- t/(�///� T Disposal Field (Specify Requirements)- ..__... _------------------------ -------------------- -- M 1 � ------------------------------------''-<=---------k---- ----;-y-- ------------------------------------------------- --------- --------------------------------_-- -- r ------------------- ------------------- ----- ------- ------ ------- r P (Draw existing and required addition on reverse si hereby certify that'I have prepared this application andrthat the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Ruies_:.'and Regulations of: the San Joaquin'Local Health District. Horne owner or licensed agents signature certifies the following:!* "I certify that in the performance of`fhe work for which thisermit is issued I shall riot p employ p y an y person in such manner as to}beco a subject to W kn s ompensation laws of California." Signe 't`c i �• - ----- --- ----Owner J 1 By . - Title G - � 1 R , --- -. - Of other than owner) FOR'DEPARTMENTUSE ONLY APPLICATION?ACCEPTED BY ----- ---------------- ------- =---------------- ------DATE.-- -- ---1 J ----------- DIVISION OF LAND NUMBER =--- --------- '`.- --------------------- DA-TE-------- --- - ADDITIONAL COMMENTS----------------------- -- `__ ------•------------------------------- -- --- - _.. --------------- --------------- - -------------------------------------------- Final -----=Final Inspection by:- --------Date.--- EH 13 24 N JOAQUIN LOCAL HEALTH DISTRICT F&S 21677. 76 3M