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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION -PERMIT 11 (Complete in Triplicate) Permit N8.7f_'_)1 --------------------------• .................. 'I Date Issued_�_-f.-Z •••••-..•.••............................................. This Permit Expires 1 Year From Date Issued I� Application is hereby made to.the San Joaquin Local Health District for a permit to construct and_install the work herein described. This application is made in compliance with County Ordinance No, 549 and existing Rules and Regulations; JOB ADDRESS/LOCATION. X3. 342- . 4 CENSUS TRACT�'_. ................................. ' -.y.�' ....................... Owner's Name _ . .__. _- _. . . .. �. .�" iPhone46 -- .. ,I 9r�� -- �XAddress- ----- Ct � Contractor's Name................._ �` ---------License #.-_ - ---..Phone.: , `. f ......... a. Installation will serve: f Residence ] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other- - - --------------- ---------------------- Number of living units:-_..,t'-.-------Number of bedrooms............GarbRage,Grinder--_.__-._.1ot Size.-_/. �.- .'2 CD..- Water Supply: Public System .and name-- ` - 4)44f—r----------- ------ --- ----- ---- 1----- ------Private ❑�'. Character of soil to a depth of 3 feet; Sand ❑ SiltE] . Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam 0 Hardpan ❑ Adobe Fill Material _ ____ _ If yes, type-,-..--------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must.be placed on reverse side.) NEW INSTALLATION: (No 'septic tank or seepage pit permitted if public sewer is available within 200 feeit,) PACKAGE TREATMENT [ } SEPTIC TANK (� Size................ .. c _�. - Depth._:� ....---.-.- Capacity.. //,Q_�.Q..-__Type.Fi _. .Material....«ll. ----------No. Compartments.!=---.... ............. .. i it R� Distance to nearest: Well.----.,`!�/� /-- -------- ---------Foundation......�.._. ........Prap. Line-.5-..- -. - -.--.- r . LEACHING LINE [e No. of Lines o2-.....:---------Length of each lines._ - ..--gs__...:_. Total Lenngth ....I:r.�.-Q.._.:_-_...__......._.___. D' Sox- -.Type Filter Material.._�.'A. Depth Filter Material.. -_.--/ .........-.�................. ..-.------_:-. k ' '_ I� - D'sstanceto nearest:,Wall__.-f��''��__.__....Foundation�..�.�- ------- ---- --Property Line_.` ........ SEEPAGE PIT Depth_62_�,. _ _Diameter_-:A_�--_____._.Number-------- ___________________ Rock Filled Yes�f No k T '/ i r Water Table .Depth.._.. Sd 0------ ---------------------Rock Size.....G. .?� . ' Distance to nearest: Well--_---�............-=------Foundation._..........._ ..�-Prop. Lfine--- REPAIR/ADDITION (Prev. Sanitation Permit#------------------ --- Date-------------- --------.------..._) Septic Tank (Specify Requirements)------ -------------- ....................;._-----................. - Disposal Field (Specify Requirements)....:.---------------_ ---I'-------- ------- - •---•----------- ---------- -. -------•-------- i ---------- �. -(Draw existing and required addition on reverse side[ > a 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 i signature certifies the following: I� k u "1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as 1 tobecomesubject to W,..- - en's--Co�;►pensa s of Califon Owner ii V si((//� ,1 B -------------- ._ .�. - " y..............•----- - � � .._....Title--- -- ---- -- I (If other than owner) k Oft DEPIIRTMENT USE ONLY APPLICATION ACCEPTED BY_ ._...-- - ( ' ._....--DATE DIVISION OF LAND NUMBER-------------- -- E , ... - DATE.. , --- - -- - - ........ ADDITIONAL COMMENTSa ' ...._. Nw .. -: .. --- ------------------------ ------------------ ---------------I-------------- --- -------------------------------------------------- -- ..----:... . ......... -I- ............... -- -------------------------------------------------- ------- ----- .---- --- ---.._...- \ ---- --------------- -- Final Final lnspecrion by. Date. 7 E" 13 2,4-, i SAN JOAQUIN LOCAL HEALTH DISTRICT ! F&S 21677 REV. 7/76 3M