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FORTOFFICE USE: FOR OFFICE-USE: APPLICATION FOR SANITATION PERMIT 7 ,� ------------------------------------------ ---------- Permit No.--- ---------------- ------- ----- iCamplete in Triplicate] ----- _.------------- Date Issued___ __ -.--.._- -----------..---------------------------_----------___ __ This Permit Expires t Year From Date Issued Application iNereby 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 witR County Orclinance'�No. 549 and existing"Rules and Regulations: L JOB ADDRESS/ .z.,�•. � �._.. ,.� .. ...� LOCATION T-.. .:.`_ -T_ ,5 , sJ___. yCe41oC,._ CO _ NSUS TRACT. ---- --- �^ . ,r I] Owner's Name =-' cJ 1L. -------------- - ----- --- Phone-- - �.. _ .:. + Address TS '- 5-- - - ---zip---9 --- -- -------- Contractor's Name-----0 .-C47,,OC .e---------------License # ." --Phone-_.k_ Y-__!-``j_7 4-6 lnstallation'will serve: Residence ❑ Apartment House❑ Commercial ❑ Trailer Court ❑ f ' M16tel ❑ Other :. A6P----------- Number of living units:------_4-Num er,of,bedrooms _-, Gar..bage`_Gr rider-r--s :Lot-Size_-- 4 � .. Water Supply: Public System and narcie"' '. - -- #._Private i Character of soil to a depth of 3 feet: 'Sand 0 'Silt❑ kClay ❑ Peat❑ Sandy Loam ❑ ;Clay Loam, Ha Aa dobe❑ Fill Material------------Ifs, type----------.- F 1 (Plot plan, showing size of lot, location of syste`6 in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank�o�,see a e; it � i p p g �' permitted if pub�c sewer is available within 200 feet,] PACKAGE TREATMENT [ ] SEPTIC TANK [ }��,,rr�` Size__:____-5 1Q �__________ ___________Liquid Depth___. ._____________ Capacity� QU;:__ Cl`ypeMpterialNo Compartments_______ .-_ _.____, ---__._ r`� t Distance to neares : Well-- --- -1 ----------------------Foundation _. --------------Prop. Line_.-- 0_ -----------� IEACHING•LINE. [ } No. of Lines _ .---.Length.of ea�h line ` ,�a � =__Total Length.. �—�_i_� pp ' .� 'D' Box .�'r' "ype Filter Material! __1L�.�CSepth Filter`Materiol'_'_-.--- rr [ _ Distance to nearest: Well_'i------ �--._Diame#er.��1`--��----._FoundationProperty Line.--------s�-------------'--. [ 1 p umkier ------------- Rock Filled Yes No 1 l Water'Table.Depth- =----------------------- - Rock Size-------r, ----------------------------------- r . --_-.-Foundation---_. _-----. . � _; Distance.to nearest: Well---'---�- - -- -. �---------------- Prop• Line---------�_�� REPAIR/ADDITION (Pre'v. 5anitbtion Permit#-- -- '.------ ----- ------.Date------.._--_-- __-_:-__) Septic Tank (Specify Requirements) = - -------------------------------- = ------- ---- ------------ = '� i ------------ --� - -i - Disposal Field(Specify Requirements) - ------------------------------------ -------------------------------------------- - ------=----------------- - t ! ry .- ------------- ------ , -------- - --------- ----- ----- ----:----.-'-.--.. ---- -------------.-.--------- ------ t -----=--- ----- ------------------------------------ e. =---------- ------------------- -------------------- (Drawe'existing and.. addition on reverse side) _ I hereby certify-that l-have prepared thi application and that,the work will be done in,,accordance with,n Joaquin County/ Ordinances, State Laws, and 461es-and Regulations of the San Jb-aquin-Local'-Hea th District. Home owner or licensed agents signature certifies the following: i "I certify that in the perform_ ance'of the work for which this permit is'issued, .I shall not employ any person in suchmanner as to become sub'ect to or m s Coensation law .of,California." Signed _ ---- --411'.x -----=-------Owner N ------- �} I BY-' � - --------------------------Title -U ---- -------------------------- r� 'E t J: (I her than"bwAerJ f ' 'FOR DEPARTMENT USE ONLY' APPLICATION[,ACCEPTED BY- "` -� t llV -------------------- --1--------.-_DATE.- ------ -- -`^- a. F DIVISION OF LAND NUMBER= = ------------------------ --------- ----- -f :. ----DATES- =-------------------------------------- ADDITIONAL = yADDITIONAL COMMENTS ` -- :` �-- - ' I = . -= ------------------------------------------------------------------------------------- ---------------------------------.. ------------------- -_ ------- r, * _ -v------------------------------------ p y - Final Inspection :b - - ='-'• -- -=� --- --------1!1!- - ---- -----------------------------------------Date ==------ ---- �-��----- ---- --- EH 13 t3 24 SAN JOAQUIN LOCAL HEALTH DISTRICT FES 21677 REV.7/76 3M i