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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------ - ' (Complete in Triplicate) Permit No. ( 7-- -- --------------------------------------------------------- ----------------------------------- This Permit Expires 1 Year From Date Issued Date Issued__-__ -_ _ _. Application is hereby made to the San Joaquin Local Health District for a permit.to construct andinstall tke work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIONI- 1_ 2 0 I CENSUS TRACT Owner's Name_.___R_«�'I+AR+D ' CRS S�._._- �' { ri� hCG ,3 - 7a22 _ = ` = - Phone---a Address.' qAJ Ct "._." .. to S 336 . . ---------6tY---1C-A---------- �iA ------------- ----------- ------------- -- --------License #__.. J� -------Phone.. Contractor's Name.------- , e�Q__CarL�' 7 123 sE,Ss4 Installation will,serve: ` Residence 2"' Apartment House.❑ 'Commercial ❑ Trailer Courts - �, __;.. ..; .- Motel ❑ Other---`---------=------------------------------ Number of living units:____ ____________Number of bedrooms_-�:....Garbage Grinder---'___,.'.-Lot-Size_:__:_ :r_, C �. Water Supply: Public System:and'name i ---------------- �. :. _ o y ---------Private�❑= � Character of soil to a depth of 3 feet: Sande Silt❑ 'Clay❑ Peat ❑ Sandy koam ❑ ala oam Hardpan ❑ Adobe ❑ Fill Material`_..-_._____If yes, type-._'.__ €_ __________________ (Plot plan, showing size of lot, location of system in relation W wells, b it& s, etc.-must be placed on reverse side.) NEW INSTALLATION-- i{No':septic tgnk 'or seepage :pit permitted if public sewer is'available within 200'feet,) PACKAGE TREATMENT-[ ]' 47-SEPTIC TANK ty l ____, .________ !M Liquid Depth.__ --_.�__..__ " . i--- Compartments ;------------------------------ Ca acitY Typ�e A : No, Distance to nearest: Well _j. F�aundation ^�� .._.__._Prop. Line______ _VV'� LEACHING LINE' [ ] No, of Linesr_ _-�_____ :_.__;Length.of each line _- s_ _,___,Total Length.-.,2.85___-______ _ �] - `�- Yp -- p , aterial--------- -- ------------------------------ - t e i Q Box.__ __. T' a filter Material __ _ ____ De th Filter M Distance to nearest. Wel! I-----_,ound6tion _ -- °__ Property Line __ --------------------- SEEPAGE _ ________________ SEEPAGE PIT [ ] Dept r i p Qiameter _-_ Number__- ------- Rock Filled 'Yes ❑ No ❑ ► Water Table Depth [ }---------------f--=--------- .Rock Size-------=--------------- Distance'ao nearest: Wel ----------- i Foundation = Prop. Line ; :t� f-t ; 'rte` REPAIR/ADDITION (Prev. Sanitation;Permit#------ -------------- - ------------ -----`Date------ ------ :--- ------- - ) Septic Tank (Specify Requiremenfis) - - ------- ==: p I ----------------------------------------------------------- -a - ',._._. Disposal Field (Specify Requirements), 1 ! = - - = ------- •--- ------------ - -�' :. r � _ --------------------------------- - �---- --- -. - --------- --- ------------- `(Draw existing and required addition on reverse sided I hereby certify that I have prepared this application and:hat the 'work will-be done,,in accordance with San Joaquin County, Ordinances,' State laws, and Rules c and Regulations oi\the";San Joaquin LocaljFlealtl\District, Home owner or licensed agents signature certifies the following: "I certify that in the performance of the:work'.for which this permit is issued, I shall not employ'ciny person in such manner as to become subject to 4Workma 's Compensationlaws of California,". "' : gSigned- ------ ---- -- --- ---- ----- I- - r LB =----------- Taley --------- -was :han'owner) NR DEP RTM ONLY' APPLICATION ACCEPTED BY--- C '__ :. ,y,�e:ri..- --_ DATE....--/1'3-5,77------ '------- ---- DIVISION OF LAND NUMBER -- --- --- ----------------------------------=---- - - -------- - - - --------'---------DATE----- ADUFT idNAL COMMENTS-�------------- -----•--- ---------------- =------- -------------------------- - - I { "t - - ------------- Final Ins ection,bY= � OAQUINLOCAL HEALTH DISTRICT' ". Date - -�--- /3 ----- t sx 13 24 Fas 21677 Rev. 7176 sin