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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. � )- �d � ' (Complete in Triplicate) -------- i� Date Issued_____ _ _-S77 ------------ -- -- - - - --- 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 and Regulations: JOB ADDRESS/LOCATION �- e ��/,u_ _CEIdSUS TRACT Owner's Name- -1..__. _C � i rc�.. -�_t_--- -.--.--. Phone Address-- > z /_< City�4 % Zip--.- Contractor's Name--. f .--.- - -- - License #�7�f�f Phone-- --------- r - � Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other--- - - ------- ----- -------- - Number of living units: Number of bedrooms__-Garbage Grinder_. _Lot Size.. .�_1C_ --------- Water Supply: Public System and name -- ----- - -- - --- - ----------- Private Character of soil to a depth of 3 feet: Sand ❑ SjJt-fir Clay [] Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material IV-0. If yes, type_ _______ --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.( NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is avoilgl le within 200 feet) REATMEI�T [ ] SEPTIC TANK $iz / 1!�r' PACKAGE T ] ( _- _X-_- --/ Liquid Depth Capacity-- .___-. - TYPe 'w-- - -------Material_ No. Compartments -17:): Distance to nearest: Well_ l� S_ l --Foundation ----1 Prop. Line LEACHING LINE [ No. of Lines_ Length of each line_. - ---------Total Length._./_Z_ -f-. 'D' Box__. -6Type Filter Material -_ Depth Filter Material. S Distanc�to nearest: Well .� _Founds#ion.. _ _ °`_--. __Property Line ___ -- SEEPAGE PIT [�'� Depth r .'' .Diameter _ _ r -------- Number f / Rock Filled Yes o Water Table Depth / �Z -� �i = ----------- - --- ----- / .. -Rock Size J---- "-------. - - - Distance to nearest: Well _ .-- - d ------ -=- -Foundation.-- l f"J f ---. .Prop. Line.-~5'r--- -- REPAIR/ADDITION (Prev. Sanitation Permit#_ _______ ______ _ f ------ -- -- -- Date ---_- --- Septic Tank (Specify Requirements)__ --------- ------------ ^- ---------- --------- ---------- Disposal Field (Specify Requirements) _ ------- - --- - ---------- -- --------- -- -------- -- - -- - ------ -- ------- (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 not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed_.. - ---- --- -- --- - Owner ---- - ,F By-------------- - r --- -Q- ----- -- -- ------ Title .- - - - - /((f other than owner[ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ ------ --�c s •, ---- -------- DATE DIVISION OF LAND NUMBER. - DATE .------- NAL COMMENTS------ --------- - -- - ---- ------ -- -- - -------- t Final Inspection by: 1 --- ---- - J _ - -- 4y} ��. � � _ - Date ._ EH 13 24 SAN JOAQUIN LOCAL�HEALTH DISTRICT Fss 21677 REV. 7176 3M