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,.. :. . . _ FOR OFFICE USE: tt FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT . Permit -------------- (Complete in Triplicate? USE- it, -29 Date issued-, .- - �-- - s --------------------------- This Permit Expires 1 Year From Date Issued stal the hereby made to the San Joaquin Local Health District for and exit to construct and in sting ng Rules and Regulations: Work herein described, Application is he y This application p { lication is made in compliance with C,ounty Ordinances - �. p CENSUS 61.18 TRACT / - JOB ADDRESS/LOCATION.-._,--- _� ----------------P.h • A.�]I- . - IV.- . --- - Owner's Name. . City ��c► ._ = Zip c -- Address__.:. :y �.? - PhoneJ� ~ � _ License #------------ '.- p u--- -- 7 - -------- ----- - Contractor's Name--. --- N7 Trailer Court ❑ A artment House.❑ commercial -. mm rciai ❑ Residence ❑ p - installation will serve: r --------------------- Mo �/ ❑ Other-: -- i .. tel _... � p -- ---- --- : -g :_.. = Lot Size_ �r - Private Number of living units:._'._-_.'-- . Numbeer of bedr.00ms-:--- Garbo e. rin er--. Water Supply: Public System and na. F.. peat❑ Sandy Loam ❑ Clay Lo ❑ "Silt ❑ :. t Loom Character of soil.to a depth of 3 feet: Sand [} _ _" -- ' Hardpan` Adobe ❑ Material_-..-:____-.If Yes,type-- Fill ic. laced on reverse side.) s""i l _. .. 4 J Plot plan showing size of lot, location of system in relation to wedsifbuublicgsewer is available within 200 feet,} 1/ C i p ' NEW INSTALLATION: .(No septic;tan k'-orkseepage pit perm p i ---_ . Size . _ l�� - Liqu d Depth SEPTIC TANK ['1" PACKAGE TREATMENT ["1' _ , J _.15��-tNla_tarial.--:-�_--._--- ---= '.No. Ca��tments. _. -- Ca 'a �( Type- --`-- - % ! ------------ p Y --- Pro Line n�` � y j Foundarion-":� :f -------_ p ;r ' _pistance.to nearest: Well----f"10 ----------- .--.Total Length.� � �-------------------------- ---- ---�----- ------- Length of each line.- --} -------- ---------------------- /f ------ ' LEACHING LINE. [:1 Na. of Lines -- _ T J�"a 1 AVO/1 1 Depth Filter Material-----------1 � , D' Box _. --Type- Materia -,l,,^...-�_--� m Distance to nearest: Well.--- -- ------Foundation------ ------- Property Line-- - -- - -- # ------- `D ameter_ _ -- ------------------- timber � Rock Filled i Yes SEEPAGE PIT L ] Depth-_ .-:-:-- p k Water TableDe :th------------- ' t . _. Rock Size.------ ' - I Distance;to nearest: )Nell... " ' = -Foundation------------- `.Prop. Line. 3 f .�� Date. -- ---------------------- -- i- ' I REPAIR/ADDITION ( rev-Scinitation•Permlt# -;-- s; { u '� ---------- --------------Septic.Tank (Specify Requirements} ------------- e .�-� � �� — . V ------ its) - " ----------------------------- - . }.� s,,, -_N ------------ - -. --- S eci_f Requirements}'-_ l J -- Disposal Field l P Y >o ------ --=- -. . ----- ------ ------------- _ � . 1s _l-_!_ �- - --- 71 4___ _-.__i_ ____.-""_-"-.----------"_________________________ l =------------- , .. ` i (Draw existing and required addition ori reverse side) �.� ie _. l _ _ lication and at"the work will-be done •in accordcin a with SanJoa u n County . agents I hereby certify thbt l"have prepared thji dpp i a, ffi l Ordinances, State�Laws, and Rules and Regulatidins f the San Joaquin Local�He`alth�Distnct�HorrAll +erowner or licensed ag T-- — -"K" signature certifies the following: to any person in such manner as 1 t I "I certify that in the.performance-of.the work for which this permit is issued, :I. sha not employ to become subject T14-1 o W,r- '"s;Compensatioa laws of..California.". r _. ------Owner. ,• _ . . Signed -------- Title. e (If other than owner) FOR DEPARTMENT USE ONLY i DE ' 0 DATE i APPLICATION ACCEPTED BY-. ;` _. ._--- DATE: ___ -. " - ------ - DIVISION OF LAND NUMBER _ ti .f �� _ - -r - 0.--- {4 •_ •- . __ __ - __ - ---- •• _- F ADDITIONAL COMMENTS t--.T--` - --- ----- ---- ------------------ I ------- ---- 1 ------ -------- ------ - .--� ------------- --------- - _ - 1 _ .. ,.� .�...Date.. = __ _ _ ___ - - F&5 21677 REV. 7/76; Final Inspection by:---- , i EH 13 2b SAN J AQUIN LOCAL HEALTH DISTRICT