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'FOR OFFICE --USE: Y FOR OFFICE USE: - APPLICATION FOR SANITATION PERMIT -------------------------------- --------- (Complete in;'Trip(icate) Permit No._7 S--,5-,77 ------------- ---- --------- - J----------- ------- > 14 is, Date lssuecl__7—�___7`p ------------------ ------- -------- ----------- This Permit Expires1 Year FroFromDate lssuid Application is hereby made to the San Joaquin Local Health District for a permit to construct and install e-work herein described. This application is made in compliance with Count Or - ance.N� 549 Va existing.1 e x i fi, Rules' and Regulations: JOB ADDRESS/LOCATION--------------._2 Q . ____h � - - ---- --- ---------- 'CENSUS TRACT._______ --------------- 7 1 �4_� 5 : �-------------------- Owner's Name---------t--- 5 Te 77 -- -------7- -------------------------------- /Y ------------------Phone-_',-------------L---------------------- -------------------------7------------------ ------------I--------------- Address--------------5-/9 1" - ------------------city -----------------Zip--- ------- ------------------- �4 0/7---_Y----------/V----------------------7----License #----------------------- --Phone---------------------------------- Contractor's Name__._0FZ, .50 Installation will serve: Residence Xr Apartment House E] Commercial 0Trailer Court F� Motel E] Other-----------% I " 11 4 ----.-------------------- Number of living units:_____ _:_-____Number of bedrooms'_____-Garbage Grinder------------Lot Size_____'_____-.------------- ------------------------------- Water Supply: Public System and name-: - ----------------------------------------- ------------------------------------------------------------------------------------Private J Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay E] Peat Sandy Loam 1Z Clay Loam E] Hardpan F-1 Adobe' Fill Material yes, type----------------- - --------------- (Plot plan, showing size of lot, locatio n of system in relation to�wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION:, '(No septic tank or 'seep6ge pit permitted ifbl'ublic sewer is availawithin 200 feet,)R e PACKAGE TREATMENT [J ., SEPTIC TANK -Size____ _ __ --------------------------- ---------Liquid Depth._ ------------- Capacity__JA-047-------Type_elr --------- ---No.' Compartments---Z-- ---------------------------- to.nearest:,-Well_'_13,�" -----------------------------Foundation------1-9--1-------'--Prop. Line---I-lq *- - --------- --- LEACHING LINE' No. of Lines________ ------------ Length of each line--------90----- ------------Total Len' th.-Arp- 9 ----------------- DBox_--J.'-',..Type Filter Material Depth Filter Material ------------- ------------ ----------------------- Dista-'rice'to nearest: Well-----/T�---------_____Foundation__: - -------------Property Line----X4000--------------------- • SEEPAGE PIT Depth' W:4AWd'emeter........................Number--------2'---------------------- Rock Filled Yes No.0 Water-t6ble Depth---:----------------------- --------------------------------Rock Size---------------------- "'Distance ------------------------------Foundation------------------------- Prop. Line____ ----------------------- REPAIR/ADDITION (Preva'Sanitation,Perm I it #__F__________:_____---------------- --__________:Date__________________: - ----------- Septic Tank (Specify Requirements)----------- -------------- --------------------------------------- --------I---------------------------- ------------------------------- --------- Disposal Field (Specify Requirements)--- -------------- --------------------------------------------------------I-------I----------I--------------------------------------------- ------------ -------------:------------------ ---------------- ------------------ ----------- -----------7--------------- ---------------------------------------------------------------------------- ------------------ ----------------------------------- ------------------ -------I-------------- - -------------------------------------------------------- ------------ ------------------------------------- ------ (Draw existing and required addition on reverse side) L 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 I t' 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." -le Signed------ 'A 7, a -- --- - 5--4--- W----------------------------- - ------b- wner By--- ---- -1--------- - --------------------------- ------------------------.-_Title- ------- ------- -- --------- ---------------------- er than owner) -FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED; BY- ----------•-=-----------=-------------- -------------------DATE DIVISION OF LAND NUMBER- ------------------- ------------- = ---------------------:------------ DATE------------------------------------ ADDITIONAL COMMENTS------------------- = - - -------------- ----------------------------------------------- ---------------------------------------------------------------- - ------------I-------------------------------------------- ---------------I---------- -------------------------------- f ------------------------------- ---------------- ------------------------- ---------------------------------------------:2--------- - ------------------------------------------------------------------------ ------------------------------------------------- ------------- --------------------------------------- ----------------------- ------ ---------------------------------------------------------------------------------- - -- ---------I Final-Inspection by:--------- Z-�- - - ------ ---------- --- -- --- EH 13 24 SAN JO IN LOCAL HEALTH DISTRICT F&S 21677 REV /76 3M_