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F R OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 79 ------- Permit --- (Complete in Triplicate) > ----------------------------------3. DGf�- _.__ This Permit Expires 1 Year From Date Issued Date Issued 'SZD__=�� 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.ADDRESSJLO , eye =- JS S-i-RACT_-::_ = Owner's Name-------- -------- hone.. Address---------As --------- --- - ---- --------City P-7ZrZ_6 -- _C, trcictor's Name' .�. - � l1 ,tl ,!License # s� �l f {-Phane` r , t: Installation will serve:' Residence Apartment House ❑ Commercial Q Trailer Court ❑ _A(,lotel ❑ Other--------- ------------------ `------- qq Number of living units:__ __ ______Numb f blazlroo s - Water Garbage Gr' er___�Lot Size._`AZO/"'Y��_d_ Water Supply Publi:g System a.. nd name -_ ,» - � ^ W -------- - ---- ------- -------- ---- ------_Private ❑ Character of soile a depth of 3 feet: Sand ❑ Silt l] Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ _. H-ordpari-Q Adobe Fill Material_---------If yes,type-________ _-____- _--____ t (Plat plan, showing slate of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION 1 "fNo septic—tank or sedge pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMEN . ] SEPTIC TANK {= �•�C� __ __ ______ _________Liquid Depth-------------------- 1 (� ize -t"`=Capacity✓ -Type------ -----------------Material--------------------------No. Compartments --------------------------------- 1;stance - -------- -------- ;stance to nearest: Well __ _____ _ ________ _____ _- _-Foundation--------------------------Prop. Line--------------------------- de __ ___ __. ____ LEA-CHINGP INE b�o` of Lines-'-- / __- �____ Total Length _ _� th ea lins __!_ ____._ "Box_ $ _Type Filter Material_ _._____-__.Depth Filter Material_.-1_39__ ____ __ ________ Distance toynearV:,Well-----4�� _ _ _ ________ Foundation_ li-___ __ _ s� _______Property Line__ _- _. _ _--_ __ __ ___ ______. - _.__ ______ SEEPAGE PIT Depth__,y��-------Diameter__� ---------Number------- ------------------- Rock Filled Yes;y y No❑ Water Table Depth---------- -y-�-.------------ ------------------------------------------------ j Distance to nearest: Well___ ;-____ -____-____Foundation__-__/0__________Prop. Line_____4'----------------- � REPAIR/ADDITION (Prev. Sanitation Permit#-__-_________ ___________________.Date__..__.__--________________-______--_-_-_-___) SepticTank (Specify Requirements)------ ----- ---- ------------------------------------------------ ----- ----- --------------------------- - --- Dispospl Field (Specify Requirements _ t �Z-- y'- ,30 --------- --- ------`---- ---------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) 1 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 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 subject to Workman's Compensation laws of California." "CFfXES SEPT'^ >, SEVIER SERVICE!• Signed------- ------ ----------------- - ----- -- ---------Ownex 23 S,) Cr xL or c1 ,,n (3lif. 9520� BY- --- Title-- F�.�a - ?crJcrtrz :pr`s L�z_#1811 (If other than ow FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------- s -------------------------------------------------------------------------DATE.--- - ----- DIVISION OF LAND NUMBER-___.__ _._._____ ADDITIONAL COMMENTS----- /�' -- d'6._ _ __dZ_ � / Cf1C- " -------------------- ------------------------------------------------------------------------------------------------------ -------------------------------------------- -------------------------------------------------- -------- -------------------------- ---------------------------- -------------------------------------------------------------------------------------------------------- - ---------------- ------------------- -------------------------------- ----- - -------------------------------------------- - -------- --------- ------------- ------ - - - - ---- FinalInspection by:----------- ---------- . ------------------------------------------------------------------------------------Date---------------------- < ------------ -- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT p: F&S 21677 REV. 7/76 3M