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FOR OFFICE USE-. FOR .OFFICE USE: —APPLICATION FOR SANITATION PERMIT= -7-7 -------------- ------------------------- ------- -------- Permit No_- --------------- rn (Co plefe.,in Triplicate) --------------- ------------- 0- -------- - 77 Date Issued--_5_______________ ----- ------------- --------------- -- This Permit Expires I Year From Date Issued Application.is hereby made to the Son 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 Reg-ulations: ON----- ----- _- JOB ADDRESS/LOCATION - CENSUS TRACT:.----- _.------- - - ---------- Phone ------------ Owner's Name--- Allp-------- - ------------------------ --------- -------- ow --------------------I------------------ city---1< -2 _0........ Address 5.4-Jo- Ae!.— k- ------------- -----------------Zip--- fi 'Ike, ----License #.V'2 -----Phon2pV--------------------- ---- Co -------- ........ ... ......... Contractor's Name-- ----- A-2---- e R�sijenc�� Apartment House.E] Commercial E] Installation will serve: ITrailer Court El . 1. . . I Motel E] Other-------------- -- ---- ----------------------------- 4s: s ----Garba -2 ------------- -------- -- Number of living Uni ----/_":_SN-6mber.of.bedroorn ge Grinder------------Lot Size- -------------- ------------------------ --------7------------------------------- ------------------ Wciter Supply: Public System and'name.... ------Private fi Character of soil to a depth of 3 feet: Sand D :Silt Ll Clay El Peat EJ Sandy Loam Clay Loam El Hardpan E] Adobe E] Fill Material------------If yes, type--------- ------ ------------ - (Plot plan, showing size of lot, location of system in relation to wells, buildings,.etc. mus i t be J placed on reverse.side.) public se available within 200 feet,) INSTALLATION:— (No-septic'tank or seepage pit permitted if sewer is w - PACKAGE TREATMENT SEPTIC TANK I"I Size---------- --------------------------- ------------Liquid Depth_..----------------.-.- ot Material_ = _N Compartments------------------------- Capacity------- ------------- Type--------------:------- Distance"to nearest:.Well--------_------------- Foundation- ----------------Prop. Line_._________._._.._. .................... LEACHING LINE No. of Lines-,--_:--------------------------Length of each line-------- --- -------- ----Total Length —----- ---------- Depth Filter M D' Box_ atefial --Type Filter Mat6rial ------------ ---------------- - ------------------ t )___.Prope�ty Line-------------- - ----------- --- Distances to nearest: Well_.------- ------- Foundation-------------I----------- hfymberRock Filled Yes.E] N ------------------- -------------- -��SEEPAGE PIT Depth-- --------------Diameter-------- ---------------- --Rock`!�Ize----?_7---------_ ---------------------------------- Water Table Dep�h---------- ------- ------------- ti . - nclation) ---------- --:---'-.Prop. Line------------------ Distance'td nearest: Well------------------------------ ----------F O'u ------------ Sa itati: n-Permit#- ---------------- ------- �Date------------ ------ -----------------1 Septic {Preva n. b -------------------- _-7 ----------:--------- --- ---- ----------------------------- -------- Septic Tank {SpecifyRequirements)----- ----- -- ----- ------------- ------------------------------- -----------Dis osal Field.(Specify.,R6quirements)------- ----- ----- ---------- ----------- -- ------------------------- ---------------------------- ------------------------------------- -------------------------------------------------- --------------------------- - ------- ---------------------------------------- ------------ -------------------------- ----------------------- -----------�A----------- %. _existin ��I!qu.iriiajackdition on reverse sideF i ' -r�e , (DiraW, t'', - C^�_�_, . T - 'I and t I hereby certify that I haVe-ptepared-tbis application that thelvArk will be done in -accordance with San Joaquin County Ordinances, State' Laws; and! Rules and R dia' tions -of the San Joaquin Local Health District. Home owner or. licensed agents j. J ' signature certifies the foliowig: T, certify that"in the 'pedarm, issued, I shall not employ any person in such'manner as i�ancw;,-61F-.th--e-�work"'f-or-.�v;-hich this permit !of California." to become subject to,/,'W rkKman ts'NCompen sdiio4n:l low -;Owner Signed------- ------- iTi-le.------------------- --- ---------------------- -------------------- BY ---------- --- ---------------- ----------- ---- --------- ------- -------------- ---------1,- f other thari'!owi;e_r) _40111 DEPAR1*P4T USE ONLY' 1APPLICADON.ACCEPTED'-BV---7.... - - ------ --- s ------' ----- ------------------DATE _7 ------- DIVISIONOF LAND NUMBER.--------- ------- JMr-------------------- -- - ---------DATE ------- ---------- ------------------ -------- -- ADDITIONALCOMMENTS------------- --------------------------------- ----------------- -------------- --------------- .......... -------------- ---------_---- ------------ ------- --------------- ------ ------- ------------ ------------------- ---- ----::... ---------------------- -------------------- ------- ---------------------------- ---- -- ------- - --------------------------------------- ---------------------------------------—----------- ---- ------- --------- ---------------------- ----------- -------------- --------------------- - --- I--------------------------------- ---- -- --- -------------------- - ----------------- ---------------- ---------------- ----------------- -- ----- ----------- --------- ---------- Final Inspection-by ------ ------ ------------- ------------------------------- -------------- F&S 21677 REV. 7176 3M EH 13 24 SAN J0 QUIN LOCAL HEALTH DISTRICT