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FOR OFFICE USE: FOR OFFICE USE: , APPLICATION FOR SANITATION PERMIT. E._.f� ,��,✓; ...................................... . /�� b (Complete in-Triplicate) Permit No ..-_-. Date Issued- � •-•-•-•---•-..•----"'.---...--.. -.................. This Permit Expires I Year From Date Issued �, �. �P �. Application is hereby made to.the San Joaquin-L'ocal Health 'Disfrict for a permitto construct'and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRE y SSILOCATION...a�.'1'��. ,'._��u.N..� Y -' .Ci=NSUS TRACT Owner's Name.. 7"/fm.mA BmA�D.•�rlA-'✓: `...... - Phone...!rl"7897 Address.-..- �o.�f/7, 7�l.C.KS�tt,�G ...F'LR. �.::..-'......... ................. City___%VrroG&TW_AJ.................Zip =4t7... Contractor's Name---I?.�_A.s__Psl.e. /ss,�.:- ' License Phone --------- Installation will serve: Residence 224 Apartment House ❑ Commercial ❑ Trailer Court ❑ �JJ Motel ❑ Other Number of living units:_...... ------Number of bedrooms._4;2_.:..Garbage Grin"dar------------Lot Size.__J.��._..X.-Z- -__-..____.. Water Supply: Public System and name------------------- ---- --------------------------------------••---------------------- -----._.. . - ' ---------------- •-•----Private � Character of soil to a depth of 3 feet: : Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam 0 7" Hardpan ❑ 11. Adobe;W ,'Fill Material ' If yes, type--------.---- --- (Plot -(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: II (No septic tbnk or seepage pit permitted if public sewer is available within 200 feet,! s PACKAGE TREATMENT -----Size.- -14:4_0 -----------------------------------------Liquid Depth..--..,- Capacity- epth ..Capacity: Type...............:........ Compartments.-----a ------------ -------- A `T Dista, S 'Foundation---- d ' !� Prop,1Line c 0 ._...... LEACHING LINE. N . f ------------------ e -7 --..---------.- Total Length t. .__.i... .......t.+..'.:�.- --.-'_- DBox .:, J..Type Filter Ma#erial:. 26 - � • i Distance•to nearest: Wel!-_-- Foundatio /0 __.__.Property Lihe ��.7................ ................. n --------- ----- P Y Depth SEEPAGE PIT [ ]: p 0....Diameter....................Number......� _�.< _._ .--..._-. --- ------ Rock t=illed Yes ❑ N r 9 .��i ' Qiatan ole!`Depth---- - --------- ------- - --Rock-Size.--- ' ......---'--"- ------ l Distance -Well - ----•-•---- ---------------------------Foundation.- - ------------- Prop. .Line..--...... --- t i , REPAIR/ADDITION'(Prey. Sanitation Piermit#---I----------------------_------- Date................. - --._..---- --------- Septic Tank {Specify Requirements)....)P.e' .-F., . -. .... --.. '- ----- .. Disposal Field (Specify Requirementsf:....`-------------- --...----•--'----... -------- ---------- t x , . . I II . ---'-'--.... ... ----------------- --- .......... ---------------------------t --------------- i I (Draw existing and required addition on reverse side) { I hereby certify that I have prepared,' applicaiion.and that the work will be done in accordance with San Joaquin County Ordinances, State l Laws, and Rules II and Regulations of the tSon' Joaquin Local Health District. Home owner or licensed agents signature certifies the following: i "I certify that in the performance of!,the work .for which this permit is issued, l shall not employ any person in such manner as Signed_._..� ..�, .� ,,�_-. - ompensafion�ofF�California." tobecome subject to Workman's Owner -- ----- -------------------------- ..................................-----------'-'---.......---......:. By ether than' Title i owner) II FO DEPART E TrUSE ONLY APPLICATION ACCEPTED BY -i - ... QATE ....../ ._[ .7_.9.. ....--•- ........ QiVI510N OF LAND NUMBER .._____._.!� 7 DATE............... .. ------- ------------- - ............ ADDITIONAL COMMENTS..._._ ........ ---....----'-----'--- ------------------ -------------- ....._ ---------- - - -------- ---- --------.. " ----.....----- -'-------'- ' ..--- --------- -------------- -- ..... .... --- 0 II' ----------- ............... ----------------- ................ - ��. -- ---- ------------ ------------- ------. ---------- -•-------•-------------------------------- ---- Final-Inspection b ..._Date...___ .�.-- - --- -'--- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT � - _ F S 21677 REV. 7/76 3M