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FOR OFFICE USE: FOR OFFICE USE: i APPLICATION FOR 5�A�N[AI ON PERMIT ��------------------�t - --- - t Permit No .. P . .7.7_ ---------- (Complete in Triplicate) _ -°;_._ ------------------------------------------ ----- -------- Date. Issued ./..---- -.-_-This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Lola] i alih District•`for a per . ctt to construand install th work herein descr ed. This application is made in compliance with Cou Ordinance No. 549 and existing Rules ad Regulations: . 1 1 ----------------- ._ G ----- ----------- CENUSTRACT-------------'JOB ADDRESS/LOCAT ,: : -pi i �✓ ,Phone_ + Owner" Name.. .�Xa? ---- ----;- r;�- i Address -------3 �� 7. -- --City -=-- ----------- i �r -zip--- --- ---- ` . -G/rb Contractor's Name- � 4 �' License #-�. � -�__Phonef' Installation will serve: Residence AA artment Nouse. Corrimercial Trailer Court /J}. f ,P 0 aP ► _ Motel E) Ot.her - _._�__:_._ Nul bei of living units;_*__f_:--____Number of bedrooms,.,;------Garbage Grinder "-Lot Size----41�51C- - __"_.""._---__ + Water Supply: Public,System and name------- -------- -----` . . = :: ------P t -: --- - rive e Character of soil t a depth of 3�feet'A Sand ❑ .Si Clay ❑ Peat❑ Sandy Loam,❑ Clay Loam ❑ p r❑ - Fill Material._.__'.._ If es, type-.--- a { ,Hard an Adobe Y e = (Plot plan, showing size"of lot, Location of system in relation to'wells, buildings, etc. must be placed on reverse side.) s } t" NEW INSTALLATION: (No septic :tank or seepage :pit permitted if public sewer is available within 200 feet,), PACKAGE TREATMENT [ ] SEPTIC TANK_ [y]� ize:__ �( ___)C 5 __:=:______ Liquid Depth--- /Z ------- Capacity Nos Compartments. ________ I _ p Y-- � "- Type GdC�Mate�rial�-��- P ---------------------- lb ------- Ca acct ./Q _. - -- - ;1 �-^--f DiVt�nce,to nearest.: Well "___ .__ __.__ ; ouProp. LineaInaon ---- *. - --------- LEACHINGLINE. [ o of-LinesLegfh of line ,: J-- ., ..Total Length._ +/-C� s, �4 D' Box_i _ _ Type Filter Nlaterial:_,!'_�F ___-Depth Filter MateriaL.__� __.__.------------------------------------------ � t / t i 71 _ ' ' J ----- _"___Foundation__ ___.Property Line_._ ' Dista a to nearest: Wel!__--_ ----- a - i SEEPAGE PIT [ De th._ .�1___Diameter -- �/Rock Filled Yes [ ..r- =------ j P f Water T�ble' de th `'--=----- ----- --- - .Rock Size: /%L-X-�1�_ - .__.____Number____-___ - J 4 . Distance to nearest:Well_..__ __;_ .".":""------------------:Foundation.__.______.___.._,_.Prop. Line___ la. -- REPAIR/ADDITION (Prev. Sanitation Permit#---.------'-_-.-'"-_"-_ --- ---------------------." ------- -.---1 ` _. e --= ---------------------------------- ---------------------- Septic Tank(Specify Requirements):._- ------------------ -- ---: --- Dis osal Field S ecif Re uirements ------- --- ------------------------------------------------------------ -- -------------- P [ P Y. q ' _ � ----------------- ------ ----- ---- ---------------------------- 4 , - (Dr"aw existing and required addition•on reverse side) 1 �� I hereby certify that I have prepared this application and that the work will be done in accordance with 'Son' Joaquin County Ordinances, State Laws, and Rules .and. Regulations.of the"Son-Joaquin Local Health District. Home owner or licensed agents, k signature certifies the following: s "I co ify that in the.�performiance 6f1the-work for which this •permit is issued, 1 shdl4 not employ any person in such manner as to become -subject to Workman's.,Compensation Laws of California." t Signed--------- --- -------- ----- ,_ =. - -----------_Owner G BY- „---------- `.t - _ Title ] ` (If other than owner R_ DEPARTMENT USE ONLY = _.r --- k - ATE _ -APPICATION ACCE4EDBY: ------ -------�--=------- --- - - - ------------- --- DATE. ------------ ------ ----- ---- - ---------------------DIVISION OF LAND NUMBER ADDITIONAL COMMENTS_ _- -------- ---------=--------- ------------------------------- ;.----- ------------ ----- ------------------------- } --------------- ----------------------------------------------------------------------------------------------- ---------- -- ------------ Final Inspection b - --- �---- -_ --_------------- _- .w. Date- '� --/-3--- '" P Y= / j EH 13 24 SAN J AQUIN LOCAL HEALTH DISTRICT �,�- F&s 21677 REV, 7176 3M