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FMR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -'i------ ------------- --------------- Permit No._77n 7�__ -- -b, --- {Complete in Triplicate) d � a _y--.- __ __+-_- _ _ � - Date Issued__ ---a..�=_�J_. � -+ �I-------------------------". �.19��_ This Permit Expires 1 Year From Date Issued 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 ext ting Rules and Regulations: ENSUS TRACT------------- ----- JOB ADDRESS/'I:OCATlO � - r ____---�-� [l hone - --------------- ----' Owner's Name. ------- --- ---------- Address- -� }_ [r i - " City - ------------ ZiP Contractor s Name--�. {.�� '�` `(� L i c se # .� 111 F Phone. ��v: en � Installation,will serve: Residence Apartment House E] Com.mercial E] Trailer Court ❑ I 4• ' Motel �Oth,er -: : ._. .... -- "" - �-- . . � . L��"� Number of living units:_--_....___Number o4b'�Oroorns_�%� ._ ��'��Garbage Grinder_! __Lot.Size_-.,_. _..___ _, --, - ------------ --.--- ---- Water Su� ply: Public System and name_ , ____._______._ -.-- Pnvat r e Y YP y am ❑ Clay Loam ❑ i Hard an Adobe Fill aterial�_;._....If �, type Character of soil to a depth of 3 feet: Sand Silt Cla Peat Sand Lo } II P ❑ (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 it permitted if public sewer is avdilable within 200 feet,)_ s [ � ! _ quid Depth --------- -------- PACKAGE TREATMENT [ ] SEPTIC TANK-[` _-No. Compartments__________________________________ ' . Capacity ---- -- -TYPe ---- ---Material -�--- . -- - ";---; s Distance:to nearest: Well.- . . ---__•. Fojundati;oyn .--: fProp. Line---------------------------- - _.-- -- ______ ._ ac lne _._.Total Length. d__-__-_-_ _LEAG LINE, No. of Lines- - :_/-- -- LenJth,of -r -----s D;e th Filt`.r Material a!___ - -------- D' Box----- `.---Type Filter Material_ r` ;___Distanceto nearest: Well__� ir-4 ounda _. _--Number -__ __ _`___._ a Rock Filled Yes No SEEPAGE PIT [ l INateTable`Depth Depth meter------ '.-------=-------------------`-------=---- Rock Size-JL---------------------------------------- ' Distance tc"nearest: Welt- - -------- ---- Foundation-- ------=-- ---- ------Prop. Line- ------'_------------------ REPAIR/ADDITION (Prey: Sanitation Permit#__________________ ____ ----------'-------Date- --------- Septic Tank (Specify Requirements)--=- -------- = t . --- ------- ----- --- - --- ----- --. - �I - � - t - Disposal Field (Specify Requem ):--- - - - ---- ------------------------: --- ----- --------- II - -------- ----- ----------- -- ------ ----------------------------------------------------------' = '•----- -------- - ---- -. ' �' (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 Laws, and Rules -and Regulations of the_San Joaquin Local Health District, Home owner or licensed agents �. signature certifies the following: v "I certify that in the performance of the work for which this permit is, issued, 1 shall not employ any person in such manner as to become subject to Workman's .Compensation laws .of. California." 76►'_ .L 6,kJ/S Signed.- _' = ;_. =„: Owner AR SNGIi$ SEPTIC_. .SEWf R SERVICE . B Title. c''63 0, ro 8tockton,..Ca1'i1---95205---------- Y � - ,.Ph:`463=3209 Con s,Lic: 26717;1 - + (If other than .ow tractor 1 FOR'DEPARTMENT USE ONLY F APPLICATION ACCEPTED BY--- ------- --- --------------------- - - DATE DIVISIGN OF LAND NUMBER.------- ' ------ ----------------------------------.-.----- ----- --------- DATE--------------- ADDITIONAL COMMENTS----------------`------------------------------- �� ----------------------------------- ------- ----------------------------- •--------------------------------------- ------------- ' - - Y — - - _ ____________________________ ______________;--_J_ __ ____ ---- - -- ' - pate � .-. �r Final Inspection by:. _C/+� ---- -- _ , eH 13 24] SAN JOAQU N LOCAL HEALTH DISTRICT Fas si6n Rev. �»e snn