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FOR OFFICE USE: � � APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: 4 ; (Complete in Triplicate) Permit No..__7/--2 •-------------- -------------------------- This Permit Expires 1 Year From Date Issued - ----- ---- -- Date Application is hereby made to the San Joaquin Local Health Dist ' r a permit to construct and instal! the work herein describe This application is made in compliance with County Ordina a No. 1 nd existing Rules and Regulations: , JOB ADDRESS/LOCATIO � 1 P • - --- ---------- --- .CENSUS TRACT ------------- -------- Owner's Norrie.-__- - V - Yrp�f -t---- -------- --------------- Phone-- ------- ------ Address- - .1�_� �-- - .- --- --- -- -�---- -;--- - �---� Z ZO r--• ---- Contractor's Name------ ,r� 7 - --- -' - License #_�7- �2 1J 7 6 Phone ----------------- Installation will serve: Residence [] Apartment House E]'w Commercial ❑ Trailer Court ❑ �' ' Motel Other:--.•.-- _---_-- Water Supply: Public System and name-_- ge Grinder_-- - -Lot Size----../1.��, c� umber of living' units:------ Number of bedrooms------------Garbo ^ .� ---------------------- Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Cla ----------------- --Private Clay ❑ . Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan (Adobe❑ Fill Material__ ---------!f es type YPe----------------- ----------- (Plot pian, 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 se er is available within 200 feet,} PACKAGE TREATMENT J ) =SEPTIC TANK [ql Siz > e-� J [�L x / ----ri- Gl- ---��--.----�--- ------- Liquid Depth----4/ l- Capacity/ °a: "Type---A-44--t--Material--- . --No. Compartments------,�.�--___-- bistance to nearest: Well- _-- - -�:--- -----Foundation.-_---�_!)_ I . : - - -- {`� ------Prop. Line---�.-� 'LEACHING LINE [ Na. of Lines-----------1-----------------Length of each line----4-_0__------- 1: i 'D' Box.°•- T � tel Length. --------------------------- --------- ype Filter Material--_-49----__ r /� _ -Depth Filter Material-.---:--1-SC_------------------------------------------------- ------------- -�----------- ----- ----- i Distance to nearest: Well - -------Foundtation_-.-.l-Q_�;_� _-.- Property Line- -----� 41 SEEPAGE PIT -- ---- - [� De At P--J-Diameter-- --s-�---------Number- --- f Y -�_ I '---- --- Filled Yes �No ❑ � r Water Table Depth---=---------- -96------ --- _ --------------.Rock Size:--J� 1 / x Distance to nearest:'Well.-.__/�Q-- " un a i y� pLine--- Date- ------------ - - Fo d't'onF= - rop. Line REPAIR/ADDITION {Prey. Sanitation Perm it#-i; '" r: : :=� f Date =---------a.__. -------- 1 )Septic Tank (Specify Requirements)------------------ 'Y • -------=- ------- ------------------------------------------------- itsposal Field (Specify Requirements)' ---,,--�___.-_�--.-__- _ --_ f i ----------- ----------------------- ----- ----------------------- fi - --------------- --- ___ -----------_-_------ e --------- --------- ---—--' ---. (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 taws; and Rules and Regulations of the San Joaquin Local Health District, dome owner or licensed agents :signature certifies the following: e t"I certify that in the performance of the work for which this permit is issued, I shall not employ an to become subject to Workman's P Y Y person in such manner as E p nsation laws of California." Signed _Owner ry BY _ - - f Title (if other than'owner) ° FOR DEPARTMENT USE ONLY: # APPLICATION ACCEPTED BY_.- 010, DATE. DIVISION OF LAND NUMBER.-..-------- --- --- ------------ ------------------- ..r DATE - -------- - - . . ------------ ADDITIONAL COMMENTS-------------- ----- - -- -----------�---- -------------- ----- --------- ------------------- ------------I----------4 ------------------------------ -------- Findl Inspection by:----- ----------- Date d EH 13 24 SAN J AQUIN LOCAL HEALTH DISTRICT Fos 21677 REV. 7176 3M � a