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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------- (Complete in Triplicate) Permit No--7--------- 1�. --------------------------------------------------------- Date Issued_//--l'4-712 .......-------------.------------..---------------------- This Permit Expires 1 Year From Date Issued 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: JOB ADDRESS/LOCATION�_z/�__� '�T �f__ 'f'e� '= � — CENSUS TRACT________ _ � - --- Owner's ' - , -------------------------- ---------_-----------Phone__! 77- D/�,2----- Address J�6Lp_.-------c9._x'----R------------ - -- -. - - -- -= ---- --City@c.�"°A-------- ----------Zip----- ---- --------- Contractor's Name_p�_ �. e.2-rst<-+°-- is--_ ,c _'----------License #_%td"`F3`��3---Phone------------------ --------------- Installation will serve: Residence ❑ Aparter nt Hous ❑ Commercial ❑ Trailer Court ❑ Motel M -' Other - -- ------ D-- - _-_- ------- Number of living units:_ ------------Lot Siz --------- Water Supply: Public Systerr and name _ -.__-_ K�s2 Q -Com____ Private El Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Pe ❑ Sandy Loam ❑ Clay Loam;K Hardpan ❑ Adobe❑ Fill Material-..-------- If yes,type-------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) • ' NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) le "r o PACKAGE TREATMENT [ J ' SEPTIC TANK Size-17-X-14 __ ___-__--_ -. --_ _________Liquid Depth_ -5, ___-__ _ _No. Compartments-------------------------------- Distance __---� - Capacity/Ano------Type -,.U- Material P - Distance to nearest: Well---, ----------------------Foundation 1p----------------Prop. Line---Zp---------------- LEACHING _ _ ______-__.LEACHING LINE No;' of Lines___ __f_____ Length of each --------_-----------Total Length __12_ p__-- doo 'D'IBox __________Type Filter'Materia __ Depth Filter Material---1p_ _r�--_--------------------------------------------- i Distance to nearest: Well_N&7LAi_---___4ndation____ ___-______Property Line �'^ ___---------------------- SEEPAGE PIT De / n th_�� __..Diameter____T+t __ Number--L -/ Rock Filled Yes �' No Water Table Depth------d-%J--------------- ---------------------------Rock Size_�. ._ -3�/j_---------------------- Distance to nearest: Well1 o,_,V'E______________ ______Foundation_.Z_O__r---------Prop. Line---- __________--- REPAIR/ADDITION (Prev:Sanitation Permit#___________________.__________-__--__.-______.Date____--------------------------------------- Septic _-_- -. -______________Septic Tank (Specify Require.nents)--------------------------- -------- --------------------------------------------------------------------------------- --------- Disposal Field (Specify Requirements)-.---- ------- ---------- - - ------ ------------- ----------------------------------------- ----- ------ ------- ---- -------- - -- - - --<------------------------------------ --: (Draw existing and required addition on reverse side) I hereby certify that t have prepared this application and that the work will be "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 signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become sub'ec�t to Workman's Compensation laws of California." Signed--2i-'-A �1` R 2P5s ' ' �icC.�^ �` - Owher— By------ --- -------- ---J--- --------------- - Title--� - - -------- -------- (if other t4ion-owner R DJVPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- -- --------------- --------_-- l�'�"r1.------------------------- --DATE.---- z - - DIVISION OF LAND NUMBER ----- DATE ------------------------------------------- ADDITIONAL COMMENTS - Q. = 3 ''- ----------------------- Y� - - --- ------------------ ------- - - ------------------------------------------ - ------ 7i --------------- Fin Inspection by:------------- --- ----- -------- �---"` ---Date---------f -�� ??- EH 13 24 S N JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 Rev. 7176 3M