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4. FOR OFFICE USE; FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No 7177-'M --------------------------------- (Complete in Triplicate) -------------------------------------------- - ---------- Date Issued-!5-'�'"27 ' ------ 1"" 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 an��lattions. a rr LL�7�=". : ------ cE JOB ADDRESS/LOCATIO ."•_.' " T._ "---"- - NSI4 TRACT ` ` u Owner's Name... -=---- -- ---- - -- Rhone ;- I 7 2 FQ1� Address -- ---r J.- -' �� --` rev-`a = City f ----- : Zip�f ��c,u.z ; a -- License-#A - _R___ P4ione Com- � ..--- - Con#ractor s Name - - -- --- t Y .,. .. . Installation will serve: _ Residence ❑. Ap Otherartment Hous FW_� 6A Co— rirn. ereial-❑ Trailer Court. ❑ - Motel ❑ { fX------------ ._.. i It ' � i --- --•- LotSize.___ F --Number of living units: _ ___--"-Number ofbedroorns -._- _-_"Garbage Grinder4J " 14. �.�. ----------- Private Water Supply: Public System.and"name__ -- ? - ----- --' ----- _ --- - �T _ .�------- Character of soil to a depth of 3 feet: `. Sand ❑ Silt ❑ ;ClayO Peat❑ Sandy Loam ❑ Clay Loam ❑ t Hardpan ❑ Adobe❑ Fill Material'---------If Yes, type --- ;--- i t�� [Plot plan, showing size of lot, location of system in relatiMto wells, buildings, e-tc r-n-&r'be placed on reverse side.} S NEW INSTALLATIONS`" .(No`sieptic tank o seepage .pit permitted if public sewer is available within 200 feet,}`' _.-` Liquid Depth PACKAGE TREATMENT [ ] ""SEPTIC SANK(_-4ype [''] " Size__-- ..--- I �! Ga acit Material. No:::Compartments '' = 3 pY- _-.- - - -=--- `------- - 4 ` _Foundat.ian. } `Prop,.L-ine" - =--- - =---------AA Distance to nearest:-Well-:----_-----_------------=----•----- -- LEACHING LINE' . [ :] No.,of Lines "---- Length of.each line ... ...... .... : �,"-_Total Length -___ 1 _ - - - k ' t D' Box--------- Type Filter Material _ Tin Depth Filter•ll�dterial.................... - -. ' I # - --------------------- h ------- ---- • Distance to nearest:Wel � r-= --.Foundatio '� •"=�� Property Line - ' c ' :��: "� "`as ,�.....,.. k Filled Yes i ❑ N r SEEPAGE PIT [ ] Depth------- ---Diameter--.".-- ' Ys9 m6er = , ;. i _- Roc p ------------- .".Rock Size_.-------------------- ----- ----------------- Distance,to nearest:-Well---__.-.--_-- i „� " Water Table.De t -___._______ ___________ r Foundation-- ---- Prop. Line--------=--------------- ' �. • � REPAIR/ADDITION (Preva Sanitation Permit#- :_. Date' f � " i 014 Septic To {specify Requirementsl K t--- - -yid _ ' ( CCS z Disposal Field (Specify Requi cements}. 3. -------- - ---- ' ------------------ -- -------- -" --- ----_- --.---_______ _ ______.. _-____._ ____ _ . - f... -- _-___ _- ____...____.-___ ____.._-_. - __- . 1 __-""""_---_ ___ ___._.. - --_ f (Draw existing and required addition on reverse-side) I hereby certify that-i-have-prepo red-this application and that.the work will''lse done ink accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San JoaquinLocal Health-,District. Home owner or licensed agents signature certifies the following: "I certifyz.that in the perfor ante of the work for which this permit is issued, .] shall not employ any person in such manner as to become ubject .to Waork arrsYCorrtpen atioa 1 ws�of California." , — -^- e, ✓! Ct.2J =ti ~f- . :Owner Signed---------- -- -------- . ------------- By -- -- ------------------ ~ -- ------ (If other than owner) [ 'FOR-DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_______________ _"_-- _ .- -------DATE..___974777- -- --------------- - - ------------------------- DIVISION OF LAND NUMBER:. - --- ---------- DATE - ------------------------------------------ ADDITIONAL COMMENTS----- ------------------------- --- - ------------------- --------------------- --------------`'----------- " -- ---------------------------------- ------------------- Final Inspection,- � ------ ---------- ---=---- -----------------------------------=-------- - " _--Date: - __�,�t•-Z------'- -------- a _ ---------------------------------------------------- --------------- ,- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTR CT F EV. 7f7h 3M