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FOR OFFICE USE: = FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 6 , d`----------------------------------- (Complete in Triplicate) Permit No---7_.__~y._ At Date Issued--- 'r-------------- ! ! ` This Permit Expires 1 Year From Date Issued - 1 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 unty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIONS ...0 ---- ---- CENSUS TRACT i Owners Name. = s Jrr1hti- Phone.�. '"r,, G - r . ----- - -------------- Address = -U 'L -Gw ...' _ 'City --Zip �-- _ - --- --- th Contractor's Name rL� r �� Z-'� _____________ _____'-------------- ___._____ _ Licenseone._ Installation;will serve: !.. Residence ' artiaent House.❑ Commercial E] -Trailer Court ❑ - otet Number living units:__ '_.____Number_of..bedroorns,,__ .Garbage Grinder".----_-_!_Lot,.Size _.__�-----—------------------____[ ------ Private -_- t - Water Supply. Public System:and name- - ` --.+.._.-'.-- `.:::.: z ' t Private - = Character of soil to a',depth of 3 feet: i Sand Silt(] Clay❑2 Peat [, Sandy Lod m E] Clay Loam ❑ �- tHardpan Adobe ❑ Fill Materia!_-------.__I#yes, type__ ---=-------- s (Plot plan, showing size Of lot, location of system in relation to,welIs, buildings, etc. must be placed on reverse side,) (� tLiJ F NEW INST4kATtON: (No;'septic tank or seepage pit permitted if public sewer is available within 200 feet,] � PACKAGE f REA+TME T [ ] SEPTIC TANK '[ ] size.__ "_.__ _' ---:Liquid Depth_ ti7� k 1 Capacity_/'Zov-------TYPe rfeg-;4VlVlatarial " " _4`,No. Compartments.-'--.g----------- -------- 1)istance --- -Distance to nearest:.Well_' Ye-V-----------------------------Foundation_-_Je_. -------Prop. Line_- �.- ------ -- -------- - LEACHING. LINE [ .] o, of Lies-__._ -: --;'--:- -._.._.Length f eac l� a th Filter Mater Total Length..__.f: _C __________ __________ r.._ t. 1 _ pe R Box Type Filter Ma e a p laL.____ =/___.._._. . _ - ----- anceVo�ne't�rest: Welt-144;V-:_--___ .. Foundation . : Property Lin ........ _.-- __. SEEPAGE PI7 Depth-.... .. �. _ s ....) , ..__�$._ E [ ] p h_... .--, -L]io�ne#er- ` Nur`riber -- Rock Filled Yes,❑ No ❑ l __ _ _ ___ ----------------------------------------------- Water -- Water Table Depth --- --------- ------- -- - -: -A""Ra'ck :Size --------- - -' ----- -- --- ! Distance`to nearest: Well _;.____.`_ _'_--_. "--_.:-_---'_ ____ a nl ation - Prop Line__ ----------- REPAIV-A-DDITION (Prev[ Sanitation Permit#--`--------------------------- -----" --------------Qrrte :------------_-- ------------- ---------- W " Septic Tank [S cif Re uirements) �.__ 1 y == = ,r -- -------= - 1 J+. P P Y q] Disposal Field (Specify requirements ;-- ----r-- --- --- ----- ------- --------------------------- ----- ------------------------------------ - � t. (Draw existing and required additio�i ori reverse siOe) j+Y I hereby certify that I helve prepared this application and that the ]work will-be-done-in accordance with San !Q'quini 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 pe.orhiance of the work for which this permit is issue I—hail not emp oy any p rson in such mpnner as to become subject �'O..- orkmompiensation• laws of .Coliforitia.". Signed ` n- - Owner - -. - --- -------------------------- By ---- -- BY-.----- -------------- _ - ----------- ----- -'- ----------------- --=------=------`------=------`------- --------------Title.----- --------- --------------------- --------- ---- --------------------- s (ff other than:owner) FOR DEPARTMENT USE-ONLY: , APPLICATION ACCEPTED BY ---- --- ------ =-----------=-------------:=-- - ------=------ ---- = DATE Z-7-7 DIVISION OF LAND NUMBER----- -------- ----- ------ - DAT [--- `--- ADDITIONAL COMMEN!i! :.'_�� ,,,��- - -� � — - -A--r-� _ -----� ��°� -- ---•------------------- ---- -------------------- ----------- ------------ --- ---------- -------------- -ry. t•_ -- --- ?1 ----------------------------------- - ---------------------------------------------------------------------------- --- ------ --------------------=- ------ - ----- -------------- ------------------------------------------- ----------- Final Inspection`bYL --- ---- - - - _ --- _ ------------ ----------Date. -�---------- EH 13 24 SAN JOAQU N(LOCAL HEALTH DISTRICT 4.,�� F&5 21677 REV. / i M ,�