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FOR OFFICE USE: FOR OFFICE USE: APPLICATION.FCIR SANITATION PERMIT ------------------------------------------- y 6 {Complete in Triplicate] Permit No._7__._�-__._.. -------------------------------- --- ----------------- 6-.�/.-7I' •-•••------------------------------------------------ -- This Permit Expires 1 Year From Date Issued 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: ; J08 ADDRESS/LOCATION _..-.:._ 16, .[' -.CENSUS TRACT - --- -- ------------ Owners Name. } - ---------------- --------------- ----------------- ------- - ------- Phonec : - Contractor's Name F 1 a -------------------- kms•;Cit i9/U 1 Y i .. z�p `�33 .. . , Address ---,--p ` ` �,��-LLQ- � r� ---------------------------- ----- -- ----License # __ 1 —jP -----.Phone _ 163 Installation w3I•I serve F. Residence�� Apartment House.[ Commercial ❑ Trailer Court ❑ r] Motel ;Other---'i------`g - Number of living units: _ __:_Number,of,bedrooms ____�_Garba e Grinder------------ i Water Supply:!Public System'and�iname---- ----------------------- ---------------- = - r=----------------ip---------- Private e-t Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loom- Clay Loam ❑ # Hardpan 0. Adobe ❑ Fill Material------------_If yes, type------------------ ------- --= s a e ,� (Plot plan, showing size of lot, loi tion of,system in elation o."wells;-buildings, etc. must be placed on reverse side.) NEW INSTALLATION: - '.(No septic tank `or seepages.,pit permitt€d if public sewer is available within 200 , feet,) -----------PACKAGE TREATMENT +SEPTICTANK [c] Size_ -Liquid Depth. { Capa rc t-y, T-ype1J�L� 9aSi_.Material Distance o nearesfi,Wel! _._LI Q,- ------------ ^Foundation:_67..Q_ Prop, Line___ _ r r� LEACHING LINE [ ] No. of Lines_;--- -------- --------_._?..Lengfh_of each line �- ..____Tot,ol Lengthl- ----------- --------- 'D' tA D' Box -----------Type.Filter--�Aateriall�X� De th Filter Materia! 1 -- ----------- ^ _ __ �.-.....}..��zw.�.�..�� .�....v :- -...� -' �._."�"'i -- -? Distance;to nea"rest: Well _Jac -- ____-Foundation-. V ----- -- Pr'operty Line-_. _____________________ -Diameter --F -_'--_Number G s SEEPAGE PIT . { .] � Depth--_-�-- I � --� .. --__-;-- _ .-----_ ,� � Rock Filled:Yes ❑ No ❑ i Water Table Depth. , ; ----------- ---Rock Size----- = i i Distance to nearest: Well......-,?,,.__' _----------_-------Foundation-------------------------.Prop. Line_ __-___-____.__-___. REPAIR/ADDITION (Prev. Sanitation Permit#--------_----------------------______-._.--_-_______..Date------- -------------- -- ...________ orf" i Septic Tank (S.pecify Req.uirements]--- - -----------z.,:____:------------------------ - = = i i i c~ � - 4 Disposal. Fietld (Specify R`equirementsji----- -- ---- - ---=- ------- -- -- -----`----- ---_- . --------------------- ------- ] _d ----------- -------- -------------------- ---- ------=------- ----------------------------- - (Draw existing and required addition on reverse side) ? I hereby certify that,I 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 the San Joaquin Local Health District, Home owner or licensed agents signature certifies the following: _ "I certify that in 'the performance-of'the'work for which'this permit'is issued, 'I shall hot employ any person in such manner as to become.!'subject o an'sCompensation- laws of. s ---------------------- California." _ .. . t Signed- .,1.(If��otller'than•`owr'i`e- �_ ._ Owner BY ---- . - '---- ---------- ---' ----- ----- Title---- - . ;._ _-- 5 ... .. �� FOR-DEPARTMENT ► USE ONLY= APPLICATION ACCEPTED - = / --.-- DATE -- DIVISION OF LAND NUMBER _----------- tks'� DATE. ;"--- t --------- -- - - - ADDITIONAIL COMMENTS_-.- /��_ W 1f ` J �. __/,"� -o -� ("` F ------------------ Lew. - ..,.,,: . :, ,___ 3 = s ----- --- ---- ----------- ----=------------- ----- ,.' ---------------------- ------------------- --- ------------ ----------- ----- ---------- --- . Final Inspection by:--- " = Date .' • eH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT r&s 21677 Rev. 7176 3M