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-t -4OR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT "? (Complete in Triplicate) Permit Date Issued. ..:' .._tOf 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._...zlz17 . , ..A ----- .................................... / CENSUS TRACT Owner's Name.. ` F� L- ----- ---------------------------------- ----- --------------------------------- Phone-�,��2�.3. Address------.SA L- ...._City....5�ckif-�1.y ---------Zip---------.•-- ----------_ Contractor's Name._.Z:A_t a.._ 'r-, t:.--. J�.--- _ 'I/�`. _License _Phone. Installation will serve: Residence Apartment House E] Commercial [:] Trailer Court E:1otel ❑ Other_...... ---- .... . ...................... _ Number of living units:.-----I........Number of bedrooms...... . Garbage GrinderIV0.1ot Size... ....... ...... Water Supply: Publi m and name.- ---- ................ ............- ----- ............................................. ---__............Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe 5� Fill Material.. _..._._.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 available within 200 feet,) PACKAGE TREATMENT [ ) SEPTIC TANK f /� Size--- _._ Liquid De th.. .................. Capacity-- ��-------Type -- _.t. . _V7Materia1_ 1 a. Compartments_--- ---- ------•---- Distance to nearest: Well......_ ` ----------- -- - --- -�---........Foundation... -- ---- - -....Prop. Line---- --- • - ----------- LEACHING --- - ----LEACHING LINE [A No. of Lines .__. __...............Len Length of each line._..._wj , � g 7 --------------Total Length .. til ._.... ---..---- / or 'D' Box.1—Y.C7...Type Filter Material..._Alek..Depth Filter Material----- .-f..----------- Distance to nearest: Well- �--__ ..... Foundation-----f.O._(-------------Property Line........................ .......... . SEEPAGE PIT JJQ Depth.. Diameter...33---...Number-----/--_--- _,--------------- Rock Filled Yes No❑�. Water Table Depth...... _00............... Rock Size... 1 . . ........ Distance to nearest: Well_............. ..................... ....Foundation......40....... ---..Prop. Line..__...........__.__...� REPAIR/ADDITION (Prev. Sanitation Permit#...................................................Date.............__...-.-._._._---____.._--._-.-_-) Septic Tank (Specify Requirements)------ Disposal Field (Specify Requirements) -lA""........ -- `/..l(��1!. Q/...------ ..X... �� ---------------- ----- ---- ---------- --------------------- ------- .............. os �� ----- , , �,�c�.._ . . . (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.. _........ Q. OTitle -.:Z g ---- - - nerB (If other than( owner)AF han owner) F R PAR E T PSE OtJLY APPLICATION ACCEPTED BY . - ...... .-- ._DATE .....�V:7 46. DIVISION OF LAND NUMBER.' ............ --- -------- --------- -----------------------------------------------DATE--- --.---------...-----------. . ADDITIONALCOMMENTS _.._.. ------------ ----------------------------- ................................... -----------------_ --------- ..--._... .-- ....... -------------•----.. --- . �w . .. ------•---------.--- �y --------------------.................. - ---- l.......... ---------------------------Q-.----------------- ------ -- ............--•---- ------- ............ t �l`�'r/ .....------•-------- �j ,�� v ...... •--------....Y-- ----------- ---------- -- --- --._._... ... .. ... Final Inspection b Date.__ .._ .- A:l ) -E .. .. - EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M