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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ (� ------------------------- Permit No._.7�-"I (� (Complete in Triplicate} -------------------J- -- --/ '� Date Issued._�`�/�7� -------------------- ------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local•Healtb District:for a-permit{to construct and install the work herein described. This application_is made_in.complionce_w.i.th_County-Ordnance No.",549and-existing`Rules-and Regulations x ' = _CENSUS TRACT--------- ---------------------- ----ADDRESS/LOCATION_.._3D ----- - --------- -- -- ----------------------- Owner's Name...... Ls!j � - ----- ------ ---- - ----- - P ; ` --- - --- - ' ----- ---- one--- .{_ Phone � Address = ��I�-`-'----- ----------- ------------------CITY ? ZEA- Contractor's Name-- -----�i1�yc ------- ---- ------ - -----------------License #J --'��---Phane---------------------------------- In tallation will serve: Residence ❑: Apartment House.0 Commercial ❑ ;Trailer Court ❑_, .j.Y....-.{..,.._.. r--Motel ❑ ' Other---.-- �'Ig___ .��.. --+' i- f� 6 Number of living units:__'___.__,____ _Number of..bedrooms____ �__Garba a Grinde.r._.=.,..._ _Lot.Size__-_7 _._ X_-_ ___3._.______ _.____.-_____5-_._ Water Su ply: Public System and name---:------_'--- ------------------- ------------f ------------------------------------------ Priya , to Cha ratter of soil to a depth of 3 feet; Sand ❑ .Silt ❑ Clay❑.tf Peat ❑ Sandy Loam ❑ `!Clay Loam ❑ Hardpan- p Adobe ❑ Fill yes,tYPe=----------------------`----__--- (Plot plan, showing size of lot, location of system in relation to wells;`buildings, etc. must b41aced on reverse side.) NEW INSTALLATION: (No septic tank or seepage -pit permitted if public•sewer is available within 200 feet,} Cy PACKAGE TREATMENTS [-;] SEPTIC TANK [' ] ------ -----___` .-- "----f ----------{'---._Liquid Depth.. `` -----------------Mater'ial_---.r"t ' : = _No. Compartments � I 'Distance to nearest: Well-. _...,_..:__777n-�---_---------------- Foundation----= :--:--------Prop. Line-i-------------------------- LEACHING UNE, ["] No. of Lines_ _._; .__._-Length of each line ._ �- -Total Length.;_____---------y--------------------- D' __-___ _ - D' Box Type Filter Material-----------------------Depth'Filter'MateriaL_-___.__`____ ____ _:.----------Foundatio ------------------ Distance to nearest: Well-, ------------------------- n_.--------_, Property Line--------- - ---------- . ,---� _ Number - Rock Filled SEEPAGE PIT [ ] Depth---- -----------Diameter--.--------------- -- - ---------- es ❑ No ❑ 1 Water Table.Depth---'------ ------------- ------- --=---- '- --- ____.Rock Size-------------- ---- -----------------s----- : Distance to nearest:'WelL�------,____._ .. --_---Foundation---- Prop, Line__________________ REPAIR/ADDITION (Prev. Sanitation!Permit _cJ_5 __7------------- _-Dcite-_o2. -----------------) Septic Tank (Specify Requirements)-----=--------- ----------------------------------- --------------- Disposal Field (Specify Requirements)------ ` ----------------------------o- ---------•--------------- = ---------------------=- ------ --------------- I l --------------------- ---------------------- ---- - ------- ------ .� ,I .. (Draw existing and required addition"on reverse side! s I hereby certify that I have prepared this:application'a'nd 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: _ ii "I certify that in the performance of'the'`work for"which' this perniit'is issued, I shall not employ any person in such manner as to 'become subject to Workman's. Compensotiow.laws. of California.." Signed- ;:--- - - ----------- --- ---- caner __. O - . BY� -----=------- - ; -- >L_ - - ---------Tale--.-- -- _: ----- --- ------------------------------ -=--_-.- t i (If-other than owner) e t FOR DEPARTMENT USE ONLY APhICATON ACCEPTED-BY - --- s'�til � �-G'C� DATE----------------- -- ' 7 -- DIVIS ONIOF LAND NUMBER -------------�----- �-------------- - +�------� --- --,--- -----------=-------- -------------------- -- - -- -- ----------- --------------- -------------DATE _---_-----.----------- ------------- --`--- ADDITIONALCOMMENTS ----=------=------------ ------------------------------------- -------------------- --------------------------------------------------------- ---- -------------- t t- ` ------- -------------------------- - ------------- -- ------------------------------------- --- ---- ---------------------------- ------=------------------------- - ---------------- ----------- --------- --- ----------------- 1�1 Final !ns ecfion�b --- -----�,-------� 6_ f Date.---=------=`.�------ EH 13 24., SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/7b 3M