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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------------------------------------------- ------- (Complete in Triplicate) Permit No.____:_ ._'.._:"-'"-- --------------------------------- --------------------- Date .Issued__.-L17-""-77 ' This Permit Expires I Year From Date Issued ix)>f t pv bu,-e-- 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 comblionce with County Ordinance No, 549-and existing Rules and Regulations: JOB ADDRESS/LOCATION --.--7 ..�� C°�.c��R-G'��F�.---_ -- -- _ �.....�....._,...,..,�,.,� � -� PAPT1.°-r4--------------CENSUS.TRACI Owner's Name' V 77T2-U-L--Lam---------------------- ----- ..----=------t--- ------------ -- --�' Phone----------------------------------------- Address------ --- ��7 7 ------ L=' C�G Ov[�-P1-.L / -----..City.-MAV 1-a_�_ -'---------- ---- --Zip----------:------=-- ---- A 2 466- 3 g3-/ Contractor's Name._'__pc�1� 1`�RlZl1-l_- -5+ 5�- ht�-:------f--------------License #----- ` `F3-=---,-Phone------------- _-- Installation will serve: ' Residence Apartment House❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other__-- , •, 9 Number of living units:,__41 +_..._Number of.,be'dro0ms__2----___Garbage Grindex-------------Lot Size-----!_+.G C: --------- -- _ Water Supply: Public System,and name-.--- ------- - ~-- ---- ----------------- ----------- ------------ ----------- -------------- ------------Private Character of soil to a depth of 3 feet: Sand -Silt 'Cla9 Peat Sand Loam 'Clay Loam r ` Ward an Adobe Fill❑Material ________If e❑ Y ❑ ❑ P ❑ ❑ yes, type___------ ' (Plot plan, showing size of lot, location of.system in relation to:wells, buildings„etc. must be-placed on reverse side.) NW INSTALLATION (Nose t_.c• tak;or seepage :p it Permitted if'public� sewer is availablewithi�, 20�feet, PACKAGE TREATMENT SEPTIC TAMC �2--------------------------------------- -- - --------- _ -------`-- }--- 1q Depth-5 = Capacity_�z-�a,...,TYpe-'----` - - `' ---------No:•Compartments_.---- --k-----=--•------------------ -76V ----�=-=--- + d Material= IFoundat Distance to nearest..Wel.l__---- 7----- -------------------- ion--------- ---_ ----Prop. Line__-- -----_---#- . LEACHING LINE No. of Lines.-: --------- ~-- --- --.Length eXa h.linre.._-,:a :�"----------- Total Le-n3th._.___/4jW-------------------------- Iter ------ -- _ Material � lter Material Box--L-1. 4�PTIG_____ e th”Fi1_ ------------------------------l_____________#.... - Distance:to nearest: Well__------ ---------.Foundation-----l!7--------------Property Line._.__f_ _ ----- _--------- SEEPAGE PIT [ ] Depth----'------------D'iameter.-__________--------Number---------------.------------------ Rock Filled Yes.❑ No . _ .. . .. -------------------------- Wat;r Table'Depth -=-----=--- ----Y-Rock Size - ' . Distance'to'nearest: Well -. -------Foundation- -- --- `-;i.--n_� •�tProp Line a REPAIR/ADDITION (Prev,•Sanitation Permit#--`------"----- ---------------------------- .---,:.Date---------------------- --i -------------- Septic - -- --Septic Tank (Specify Requirements)-------------- --------------------- -------- .............................. ---------- ----=------- ``.^---------- ----=---' - �!------------------------------------------ Disposal Field {Specify Requirements,M---------------'--- -. - 1 . - . _ _ ----------- -------------- __________ _______________________________.________ -----------------------------------------------------------_____ __ ------ ------------- ______ ___________ ------------- ---------- __________ -- ----- -- �- -- --- .' - - - --:--- - - - - - re wired add ition'on reverse side) [.. _ Draw existing and' q--- . , {.. . I hereby certify that l 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. Horne owner or licensed agents signature certifies the following: "I certify that in the performance 'of'.the"work for'Which this perrriit is issued,'l shall not employ any person in such manner as ; to become subj1ect_to Workman s. ComP ensationt•laws..of. California." _. .,._. . ;. . -= Signed__._ � _ i R�f_Slz. : �� 5/� = ------ ------ � (' ' =--------- :Title ---- -- -- ----- ----- . --------------------- By le_ f (If'other than owner) k R D PARTMENT USE ONLY 1 APPLICATION ACCEPTED--BY = DATE_.__..c ./7 17-- -�----------- - DIVISION OF LAND NUMBER .----'--- ---- DATE4 '. ...... --- ------- ------------------- ------ � 1 .' ; ADDITIONAL COMMENTS------- k -----------•--- -- ----- ----------- --------- ------------------------ ------------------------------------ P -------------------------------------------------------------- -----------------Date ._ Find!•Ins Inspection b .— t...__ ------------------------------- y, . , = EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F8s 21677 REV,7/7h 3M ;