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FOR OFFICE USE: '/� # f FOR OFFICE USE7 .D APPLICATION FOR SANITATION PERMIT 3 (Complete in Triplicate) Permit No.7, �_`_____. •--------------- ------------'['/�'� ( {�-- _ This Permit Expires 1 Year From Date Issued Date Issued_.�.-,�� _ - [-.tet--�../ 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 ADDRESSAOCATION --- A� . FENSUS TRACT_____ ______-_ A_X Owner's-Name---_- % ----- - -- -- -- ` .':Phone-------------------------------------- Address ----- - ------- _ q Address-- --��. --:=------- 4----- - City --------------------Zip Contractor's Nam t_A.___= cense # Phone_40 Installation will serve.-- `Residence rV ,Apartmerft House E] Commercial ❑ Trailer Court ❑ AZo-tel �> Other----------------------------------------------- _ of living units Numb roo s_.. Garbo a Gr' der_._ P/t _ a --------------------- Numberr /____� g "tP"Lot Size_ _70, . -Z Water-Supply: Public Sirs and name___ L1 .Private ❑ Character of soi(;fo a--depth of 3 feet: Sand E] Silt E] Clay E] Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ' Fill Material --------.-If yes;-type-------------------------------- (Plot __.___.-__ .._ _________(Plot plan, showing size of lot, location of system in relation to wells, buiWings, etc. must be placed on reverse side.) NEW INSTALLATION: (No•septic tank or-tee3age pit permitted if public sewer is available within 200 feet,) tS va PACKAGE TREATMENT (�< SEPTIC TANK [ J Sli ____ -.__=__ -- _____-Liquid Depth-_ ________ Capacity-.-------- -------Type-----------------------Material--------------------------No. Compartments----------------------------------- Distance to nearest: Well _-__ ______. - . -Foundation _.__ ____Prop. Line--------------------------- LEACHING ._ -_ - - -- - ---- --- - - ------ -- - - --- -- ----- LEACHING LINE - No. of Lines___ ______,r_. . __ Length of each line.......'VQ'__!__ ___Total Length-------�0 'D' Box_--0_JP_ l- _ Type Filter Material Filter Materia ..-- ________________ -------------------------------- Distance,to nearest: Well__4__/___________Foundatiga ._-._/Q__---__."._._Property Line---'4----------------------------- A- /.__ _.=; Rock Filled Yes No SEEPAGE PIT [X Depth_ _Diameter_____ __ _ A ❑ Water Table Depth >_.___ ._ .�.-------__----___-.-__---Rock Size_._____---� Distance to nearest: Well---/ �_.�__...__.-----------foundation-----la_._�____._Prop. Line___._-__ ______-_.-. REPAIR/ADDITION (Prev. Sanitation Permit#______________-________-____.______..___.__._-.Date_________.______...____.._ ) Septic Tank (Specify Requirements)------- --------------------------------------- -- Disposal Field(Specify Requirem ts)---- ------ ------=b�'�------�------ ----- ` �- J. (Draw existing and required addition on reverse side) 1 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." ,-'0i , ,,, SEWER SERVICE Signed----- .--Owner 263 So. Oro S oc!< c + C.::lif. 95205 ------- ---------- --- ---- ----- --------- ------Title---- ---------- ---'---- `- --- _--;-a;ac,_'s L-c.#Z6Z17.� (If other than ow r FOR DEIYARTMENT USE ONLY APPLICATION ACCEPTED BY--- ----- G__ - - -- - - Z. -7/-- - --- ------------ --------------------------------------DATE.--- 71F------------------------- DIVISION OF LAND NUMBER - - -- -----------------------------------------------------------DATE----------- ----------------------------------- ADDITIONAL COMMENTS-_- -k 71b-----------, ----- Z 1ehq I �------------------------------------- ----------------------- ---------------------------- -------------- --- ---------------- ---------- ----------------------------r ---------------------------------------------- ---- --- ------ ------------------------------------------------ ----------------------------------------------------------------------- -------------------------------------- Final Inspection by:------rt i ---Date- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT f&S 21677 REV. 7/76 3M