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FOR OFFICE USE: FOR OFFICE USE: ' APPLICATION FOR SANITATION PERMIT 77- 4gS S_ .4i/----------- 4" ----------=' (Complete in Triplicate) Permit No------------- ---'---- 7 --------------- -- -------- _-------------------____ -_ 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 existing Rules and Regulations_ JOB ADDRESS/LOCATI � __. �� `�-�'.-- --- --- NSUS TRAC -""-- -- --' T OwP on ner's,N ;; .tE Address a ------ -----=-----= City cf _=. Zip- • - - _ - -__ 4q t - F= 1 ` Licenser*_Phone ' Contractor's Name___"." _- -- -"-- - - / • aa tP-� (Cl��^� V 9 a +4k Ll ai' 0 �S 1 4L Installation-will serve., Residence' ,Apartmen# House ❑ Commeraal❑ Trailer-..Court'[:] j .,Q ./ - p Motel.f❑ Oti�e'r!�_- =- ` iSt r (.'—_ Number of bedrpoins arb ge.Grinder , Lat Siz --- -� .� ` Nu ei:of living units:: s � � • . ",� ,.--------- - ,. = Water Supply: Public System and name ' Private -- -- ------ -- Character of soil to a depth of 1fee-tQNSand ❑Silt❑ Clay ❑ Pea D Sandy Loam Ll ° 'Cl a Loam ❑�C . ..�. # ,Hardpan �]' Adobe FtiII,Materia.l._._-: If yes,�type �Ls,\4 "-- b_ `1 {Plot pian, showing 'ze "of lot, locatioon�`of system in relation to wells, buildings, etc. must be placed on reverse side.} NEW INSTALLATIiON �(No se:pticM-6.kTorf seepage"�pit permitted_if public sewer is available within 200 feet,} PACKAGE TREATMENT..[ 'I `-SEPTIC TANK -11'.,. -'Size -ze "--' - '--'-• ------- ----- ---- ----- --Eiquid 'Depth._ --- ---. S . Capacity-_-,-' -'-- ` -- Type Material__' �- -___No: Compartments----------------------------------- Distance'to nearest: Well-'------ --------------- t' -----;Foundation---------------------------Prop. Line---------------------------- -------------- -- .----- - -- LEACHING LINE' [ ] No.+.of"Lines-'_--__.:------=-- ------- Length o p • - f each Lina._ __"___ _Tota en th ; ----------------- ""-- D Box1,-Typer Filter Material-a _-___ _ _De Depth Filter Material-`' ` - 1L Distance.to nearest: Well-' --Foundation-- --:---.Property Line______-__ N SEEPAGE PIT [ ] Depth----`-----------Diameter_;------------------Number--- ---------------------------- ----------------------- W ----t---------.---{---- RockjFille�l Yes ❑ o ❑ { Water Table Depth---------= 1--------- ---- -.Rock Size---- -- --------------- ' F E / • oundation-------------------- Pr me i.. I Distance.to nearest: Well"_ -__-_"__ _.� - --- � F op L I REPAIR/ADD.ITION (Prev.-Sanitation Permit#--------- t = tom`----- - -Date ---- --------'^--------------- - - 1, Septic Tank (Specify Requirements ------ --'". " "° *�t�' # -- ------- �yie n jDisposal Field (Specify,Requirements),-�-_-- 'C----- --------- --X -- $ 1 ------------------------------------------------- ta � =----- --------- ---------- ----- -- -- . ------ --- = - --------- EL _- --.., __________ __ _______________ ______________________ ---------------------_ _-._--.-_-__----__------ v r j (Draw existingand required addition on reverse side) L -# ` € 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 9the' San Joaquin Local Health_ District. Home owner or licensed agents signature certifies the following: 4 "I certify that in the perforrnance"of;the work for which this permit is issued, I shall not employ any persofn in such manneras .to become"subiect"-t6-Workman's Compensation laws"df:- kilifornia:" F Signed : ------ - - --- - ---- ------- = 3 Owner ---- -- By- [ r ----------- r,----- Title ------------- - ---- If other'than owner) T : +-_ ; -1 � . - FOR DEPARTMENT USE ONLY I DATE..--- 1 I APPLICATION ACCEPTED BY-.--- - -------=------ --- - ------------------------ C1 - "�7_"_---------- -- -------------------- OF LAND NUMBER- - --- -- ----- - --------------------- --- - -- --_------- -.- --�-- ------ ---------- = ----------------- DIVISION DATE S' ---- --=----------- -----------------------------------------� ADDITIONAL COMMENTS--- ------ -- , --------d�� - A _ -------- ---------- � t ___ __ - ___- _ _____-"_______________________________________________________________________ _____ --_ _._._-___-_ -___. -:____________________________________________ _ _ ----____"---____----___-- ",+' _ ..--- - -- -- - -----------------' --' Date Final Inspection- bY�- - ---•' - - - -�.�'-`'-�--'---- ------ ,.. .. _ .w _" �J'�� 'EH t3 24 /3AN JOAQLIIN LOCAL HEALTH DISTRICT Fas sierr RE " '�"