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_ FQR OFFICE USE: -� _ - FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 ��7 ----------------------------------0 --- (Complete in Triplicate) Permit No._7_.. _________ A 1A /� Date Issued_______________ ------------------- ------------------------------------. This Permit Expires 1 Year From Date Issued roaiiL x t s .j;.fi�,-�./ 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/LOCATIOa—qJ✓�__y---4A44"f-__el-o ------------ CENSUS TRACT-----9:;�_____________-- Owner's Name---- ------/9%0-`..........cop'We 4e --- P- ------------Phone__ARM� 7y.7 Address--------X-5✓•_S_--3Y---- -- _1Z� criG.. - 4o ' ------- ---------------------------------zi Contractor's Name------.90440 __eA----------------------------------- ---------------------------License #---------------------------Phone .---------------- Installation will serve: Residence Apartment House.❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other-------------------------------------------- Number of living units:_./________Number of bedrooms__�__Garbage Grinder,*Gt____Lot Size---- eS____________________. Water Supply: Public System and name----------------------------------------------- -------------------------------------------------------------- ------Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan :Adobe ❑ 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 sgwer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size-Z;el.S-//_.,11UC--------------------------------Liquid Depth-------------------------- Capacity--------------- _________Ca acit _-__.-Type-------....__—M iterial__ -----, -,-.-------___No. Compartments----------------------------------- Distance _------ --------- Distance to nearest: Well`------------------------------------------Foundation -------- £--_Prop. Line---------------------------%y LEACHING LINE [ ] No. of Lines_ __._.-.__.. ______-.Length of each line-----------------------------NTotal Length .__--- ------------------------------- 'D' _________ ____ _ ______'D' Box_'________Type Filter Material--------------------Depth Filter Material—-----------------------------_-- ______-______--___-.-Distance to nearest: Well----------------------.-----Foundation---------------------------.Property Line__________________________--.- SEEPAGE PIT [ ] Depth----------------Diameter--------------------Number--------------------------- ---- Rock Filled Yes ❑ No Water Table Depth---------------------------------------------------------Rock Size--------------------------------- -------- Distance to nearest.Well - __ ___ ___ ______ __----_.___-Foundation-------------- -----------Prop. Line---------------------------- REPAIR/ADDITION _ ._-___-__._-------------REPAIR/ADDITION (Prev. Sanitation Per it#----------------------------------- --------------------Date-------------------- _________ _ ____..._ _ �- Septic Tank (Specify Requirements).._ -,C�1¢/�2_--___.--�._4. �__ ___'__.__---/—�_.�� qG _ s,c.o__.__.. Disposal Field (Specify Requirements)-------------------- - __o______ ' __________ .i _ - ___ -syx_ -------- - - - ------------------------------------- --------------------------------------------------------------------------------- ----- -- (Draw existing and required addition on reverse side I hereby certify that 1 have prepared this application and that the work will be done in 6 corc%nc',,with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health DistivsT, Home owner or licensed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ dAy p:e-rspn in such manner as to become slaws of California." Signed------- .` - ----------------------------Owner BY---------------------------------------------- ----------------- -----------Title------------------------ ------------------------------------------------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - --------------------------------------------------- ---------DATE. ------------------- ;ir DIVISIONOF LAND NUMBER----------------------------------- / -- -----------------------------------------------------.DATE-------------------- --------------- ADDITIONAL COMM ENTS , i�t�3sre% Gr/%?177------------------------------------_--------------------------------------------------------- ---------------------------- -------- ------------------------------------------------------<---:--------------------------- ---------------------------- ------------------------------------------------------ ---------------------------------- ------------------------------------ --------------------- --------------------r------------------------------------------------------- - -------------------------------- ------ - ------------- - -- ------- -- -- - --------- Final Inspection by' al t ------------ ------- - flate � l 4�� :.; EH 13 24 / SAN JOAQUIN LOCAL HEALTH DISTRICT F&S21677 REV. 7/76 3M