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i S ' FOR OFFICE USE: FOR OFFICE UZk O APPLICATION FOR SANITATION PERMIT I ............... (Complete in Triplicate) Permit No... ��yy ............................ s Date Issued./ ............ •.................:.........._....._.__._........._.-... This Permit Expires 1 Year From Date Issued t i Application is hereby made to.the San Joaquin Local Health District for a permit to construct and.instal! the work herein described. Thisapplication is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: .' 22 .....CENSUS TRACT--------------•---.....-.- JOB ADDRESS/LOCATION./._J. ...... 'W [.JCC -- ---•------------- Owner's Name................. .............. -------- ---:.----Phone....... :" 03/. ....- Q -- Address - 'yR,� - City, Q .....- ZIP-g 7 =" Contractor's Name........... ........... ..License _1�63.....Phone--------------- -- ---- Installation will serve: Residence Apartment"House ❑ Commercial ❑ Trailer Court ❑ Kotel ❑ Other_.... ' _'-_" Number of living units;........ .......Number of bedrooms'-k-N�. Garbage Grinder Lot Size............... . ... ....___- :. _.._. -. Water Supply: Public System and name--.................. 4. -Private ❑ l� Character of soil to a depth of 3 feet: - Sand ❑ Silt E] Clay ❑ `Peat E] -. Sandy Loam E] Clay Loam E] Hardpan_❑,),A- obe). Fill Material . ..:.�.r.1f yes, type_h_. ................ . r (Plot plan, showing size of lot, location of system--in relation to wells, buildings, etc, must be placed on reverse side,J NEW INSTALLATION: (No septic tank or seepage pit permitted if public_sevwer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK J -] 'x-- Size--- ----- ................... - -----------------Liquid Depth.--- ---- ------ ---------- Capacity. --Capacity =---..Typ?...................:...Material.. -- ------No. Compartments------- ----- Distance to nearest: Well----- --- --------- ----Foundation..----- .........Prop. Line------ ------ ` LEACHING LINE l [ 1 � No. of Lines -----------------.Length of each line-----------------..........,_. Total Length .. .............-...... -- - ------= 'D=Box.- Type-filter Material.-,: Depth Filter Material---..................--------------------- -------- --,-:------ Distance to nearest: Well--------------------------- Foundation......-..------ --_..Property Line--.----- ' SEEPAGE PIT [ ] Depth._._-_.. .....Diameter-------------.......Number- ---- .-`----------- Rock Filled Yes ❑ No WaterTable Depth.._---------------- ------ - - - -----------------Rock Size------- ....... . -------__------------•--- f Distance to nearest: Well---------------------...............W,_'_�.Foundation--------------------.. -- Prop. Line..._.................-----. REPAIR/ADDITION (Prev. Sanitation Perm' #:----.-=-,`"- -- Rate------------------ ... .......................1 Septic Tank (Specify4Requirements).-.-.-.. -- . ------- - Disposal Field (Specify Requirements)..._.T.-L.-:_��--C _.; �.f .� ` 4^ . -------------------------------------------------' _.......:....----------------' -- .----------_.....__------.-...---------- -.-.._...-.-..._.'.-. - �. ......................................... .. _ _ _ _.(laraw_existi cljequired addition on reverse side) ; I hereby certify that I have prepare(! 'this application and that the work will be-,done in accordance with San Joaquin County i Ordinances, State Laws, and Rules and Regulations..:of' the San Joaquin Local Health District, Horne owner,or licensed agents signature certifies the following:, `' F "I certify that in the performance of`the work for which this.permlt�is issued, 1 shall not employ any person in such manner as to become subject to Workmen's Compensation laws of 'California." " Signed------------------ � Oner tile . -......By... d� f other than owner) FO !'DEPART ENT USE;ONLY APPLICATION ACCEPTED BY DATE ....-./- - 7 .70 DIVISION OF LAND NUMBER.... ....... ...... - --------- - - --------- DATE. ADDITIONAL COMMENTS.. -... \�\ ------------------------------.- ---------- ...------._....._ ................. ----------------------- ;-.- -- -- . Final Inspection b ------ .-- -- _... EH 13 24 SAN JOAQUIN LOCACHEALTH DISTRICT as 677 REV. 7/76 3M 1