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FOR OFFICE USE: FOR OFFICE USE.. APPLICATION FOR SANITATION PERMIT Permit No.7944&-f --------------------------------------- ----------- ---- (Complete in Triplicate) ----------------- ---------- ------- ------ This Permit Expires 1 Year From Date Issued Date lssued_/9_7��7-7K� --------------4 - ---------- 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 RulesandRegulations: ..CENSUS TRACT-------------------- ----------- JOB ADDRESS/(OCATIO _il --------Phone---- Owner's Name_----- --------------- -- -- --------------—-----7--------- - --� -------- --- - -- ---- ------------- ........City --------- --------Z�i p---------------------------- 41J -ZVI---- -- Address-__.-_-- ------ Phone--,-? 157 31-3 License #---—-------------------- --------------------- -- Contractor's N ci'm e Y- ------- ------- ommercial E] Trailer Court E] Installation will' serve: Residence Apartment House FTI C Mote I ❑ Other------- --- -- --------------- ---------- - 9 un�ber.of bedroo age Grinder- _,_Lot Size Number of living units:_ ms- -----Garb - ------------- Private 9-- Wciter Supply:.Public System and name...... ------------ ---------- --------------1----------------�,---------------- y Loom Peat F] Sandy Locim L] Cla Character of soil to ct depth of 13 feet: Sancl D Silt El ClaY 0 . &: Hardpan .. -1 Fill Material-__�-------If yes, type___._------------ --------------- Hardpan El Adobe,F to wells, buildings, etc. showing size bf lc�jl, lo�ati �n of-system in relationmust be placed on reverse side.) c 0 (Plot plan, . A. kr i-available within 200 feet,)NEW INSTALLATION:' ANO' �&epbge pit permitted if public sewer s a septic' tank or NJ Size....... Li - ------------------------- ------------ ------- q6id Depth PACKAGE TREATMENT 'IS'EPTIC TANK JC 1_4 Cornparfm- ents------------------------------------- Capacity -Moteria ---------- --------��Type---------------------- ----------------Fo ---------70 - unclation.-1/0------------ --Prop. Line--------------------- Distance to necir6st.-Well-. --------------- C? ----------- C. -7-------- LEACHING LINE `t ,No. of Lines_,-,-__---_------------ Leng'th of each --,Total Length--- ------------------------ `2 Ile-, D' d�Box__ ___._-Type _/" --------------------- ------------------------- Bo ?Type Filter Ma4rial-:------YA.........Depth Filter Material- :Distanc5 to nearest: ------ -----�ounclation----t_-_3�5----- -----------Property .Line__:-------------.------------------ -IRock Filled Yes,[]�J� N 0 ---------------------- ------ ❑ ---------Number SEEPAGE PIT Depth- .---Diameter_ 7 ' ' - -------------------- Rock Size-' -VA - .- -Water Table`Depth.-- ------------ -- -- bistonce-t6 nearest- Well-- , ----- ---------=--- ----------Foun�ation---------- --- Prp. L�ne--- Z5 - - REPAIR/ADDITION (Prev. Sanitation Permit ---- ------- ---------- - ------------------------------------ -------- ------------ ------------ ____ ..- -, -1 ---- 1-1----------------------- Se tic Tank (Specify Requirements)------- ---- P ------------------------- ---- -- ------------------------------------- Disposal Field (Specify Requ i rements)--- ------------- ------------ ------------—--------- - ------ - ---------------- I ----------- ---- -------------- ------ --------- ----------- ----------------- ---------------------------------- --------------- ------ ------------------- ---------- --------------------- ------- --------------'--------------------- ------- - - # ___------------------------- ------- ------- L7 (Draw existing and required 'addition on reverse side] L -that-the--�work-will-lie-do�'ne-in-accardance with San Joaquin_County I hereby-certify-that.1 have p-repared this application-and P - rict. Home owner or licensed agents n State Laws, and Rules and Regulations of.the: Sari Joaquin Health Dist Ordina ices, signature certifies the following:n. performance SSU em�p "I certify that i 'the lo;vi-,any person in such manner as rmance C;Vthe work for this permit is issued, I shallno!. r I to become subject to Wor man's Compensation laws of California." ner Signed-------- --------- ---------Ow -- --- -- --- -- -------------- ------------ ------ 610k,---------------- - ----------------- -- ------------ 4. By! ------------------------------------------ -------Z -------Title---- Of 6fher' than ;0w6er) ... ... FOR DEPARTMENT USE ONLY _DATE ZI 105 ------------- y APPLICATION ACCEPTED B)4 7" ------- -1------DATE------------------- --------- --------- ...... -----00 _ 7 ------------I ------------ DIVISION OF LAND NUMBER-------------- ------7 - ----- ------------------- ----- ADDITIONAL COMMENTS---IN-----------------------------------------------I------------- --------------- ------------- ------------------------------------------------------------------- ----------- ----------- ll ----: - . . . - ;-- - -------------------------------------------------------------------------- - --------:- ------------------------------------- ------ ------------- -------------------------------- -------- ------------------------------------ ------ -------------------------------------------------------------------------------------------------------------------:------------------------------------------- ------------- ------ --------- - -------------------------- --------------------- ------------- ------------ ----------------Date__-. - ------------ a-I Inspection by------ . -- I - - -_ ____ Fin ------I .-. - I - F,&S 21677 REV. 7/76 3M EH 13 24 SAN LOCAL HEALTH DISTRICT.,.