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FOR QFFICC USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------ �- -'-- _ (Complete in Triplicate) Permit No.-------- ___7/T 7� Date Issued_ ________'"__ -------------------,----------___- .......... This Permit Expires I Year From Date Issued f r 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: f JOB ADDRESS/LOCATION... .7,ftl D-. _-_-- L[.[`�(C'=. -'----•---------------- ------- - .-.._--.CENSUS TRACT.4`C_ OA C>--'-----' r Owner's Name..>�_ b------0 ia_1ugi---- - -------------------- ----------- // hone. 9Q. _. --------------- Address -Address ' ll !)ttr :. --' ' -- C City ' Zi - _-;; - - :. . � ��... R ------------------- Contractor's Name_L __ f? �� _.--- C'�---------------------- License #_. J� -------Phone_3�?d`-_�f-�_3_ -'-- Installation will sere: "� Residence ❑ Apartment House.❑„ Commf�ia1 ❑ Trailer Court ❑ a' - ►' Motel ❑ Other.---. _. o_r�.v _.__:. Number of living units:---- _.___-.Number of.bedrooms___,_�_-.___Garbage Grinder-----------__Lot Size,_--_ _ 4_ __- __,-_--------------- --- Water Supply: PublicSystem'and name------- ------ --------- ----- -- ------------ -. ----- -------------------------------------- Privates -r ; Hard 3 feet: Sand -Silt ❑ Clay ❑ Peat 0 Sandy Loam ❑ -Clay Loam Z n chatter o sol to a depth o an Adobe Fil!'Material_..._--____If es a ---_-- i s I p ❑ ❑ Y type ; f {Plot plan, showing size of lot, location of system in relation to wells, IoUldings,ietc.-must be'placed on reverse side.) NEW INSTALLATION: } l-. [ #(No septgcrtank�Ir It 'or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK .Size-__: xX_ _ �__ [.:� [ }� f Liquid Depth.: t� Capacity- Distance a a / cit , e___ ____'--MaterEal'_ Q� ,,- 4_.-.-No. Compartments--:----__ Distance.to_neareit:,Well_. �_�D.-----------,'------ Foundation-- --------------Prop. Line___/71)_.---_--- _ _ LEACHING LINE [Lj-r-No=of•Lines _ _ .Length�o`_f each line 7 �_- ?.Total Length„«. f '� Q/ ( � D Box -.___.._Type FilterMatenall,,,_Y _Dept h Filter Material��, = .Y---.---.. ` _ r Distanca'ta crest: Well--- �� _..____._Foun7dation__ .�____., _ Proper#y Line_ -----------.. ... 0 SEEPAGE`PIT' Depth__ __.Diameter.: .Number--. �. .,�. Rdck Filled Yesg;." No'❑ �0 ater Table;Depth _.: __ __ ___ L-111- --------------------------------------Rock Size.____._.. ---------------- W i REPAIR ADistance to nearest: Welf_.._. . ..:......:-------- -----;Foundation__> ��___._.--_-. ._..Prop. ine----___�_�.... __ _ / DITION (Prev.(PreySanitation Permit# ---------------------------------------------------Date-----=-------------------------- Septic ) C Tank (Specify Requirements[--- ------ -=----- -----------==- = = � I p --- -------------------------- ----- ---------------- ---- --- n Disposal Field (Specify Requirements)---------------------- %�` ------------------ ___________________--------------------------------- - - _ I {Draw existing and required'addition on reverse side} i 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 sigrhature certifies the following: "I certify that in a perf �pnce'of`the work for which this permit is issued, l'shodl not employ any person in such manner las to become ct to r n's Compensation' laws of.California.',' $YI"f otFi ------------ --------------- Title ----- -- -- --------' ( er than'owrier) _ as FOR DEPARTMENT USE ONLY I 6 DIVIS ONIOF LANDENUMB R.,------------------------------------- w :.._...__. ._ - DATE. ' _ _ :' " . --- :---------DATE_ - -----=-- a ADDITIONAL COMMENTS ' - . - ------------------- ---------------- ------------------------------------- -------------- ------ -----------------------' ------- --------------------- --------------- -- ---- --- :I " - ---- - - -- -- -------- - ----- ------ - -------- ------------ --- P r Final Inspection ' Date... p ion by:�' ,... -- --- EH 13 24 SAN JOAQUIN LOC HEALTH DISTRICT F&5 21677 REV. 7/76 3M'- Al. r