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FOR OFFICE USE: FOR OFFICE USE: APPLICATION. FOR SANITATION PERMIT -. --------------- --------------------------------- ------ - - No.-,77— (Complete in Triplicate) Permit No._� -__ ay --------------------------------------------------------- - 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 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--------------- ------- -----------------! 'tfR1SEJ - RAET .-= ------------------ Owner's Name------�4 ---------------------------------------------------------------------------------Phone------ ----------------------------- Address 7 C° A1U!C [t' 1 A-C/�`-----City-,41-(/c�.--/�t��LT ZiP l Contractor's Name- F -------------------------------- ----License # _ ---------Phone Installation'wiff"sai-vei Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other---- ----------------------------------------- Number of living units:____ _______Number of bedrooms__ ___Garbage'Grinder------------Lot Size________ ----------- _________._____________.__ Water Supply: Public System and name-------------------------- ------------- --------v----------------------------------------------------=---------------Private ,_- Character of soil to a depth of 3 feet: Sand E] Silt E] Clay E] Peat❑y ,Sandy Loam r% Clay Loam C] Hardpan ❑ Adobe ❑ Fill Material------------If yes,ty'pe________-_-____________-______ (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 sewn er is availatle wtt�in 200 feEit,) H PACKAGE TREATMENT [ ] SEPTIC TANK_ S` r [ ] Size--- ��-V_Aj X- — - `Liquid Depth Capacity-- --��/`� _ �_ r�� Material---^-- No. C,)portnner�ts '------__ -----____--6 Distance to nearest: Well.------4',_47 ------------------------__Foundation _ ' Prop. Line___------------------ No. _ __ LINE [ ] No. of Lines__ --------------------Length ofieoc�h line. `9`3 _ Total..Leng1___ _-------------------- LEACHING /G r 'D' Box---/_____Type Filter Material__/ _-�4 epth iillerw§ferial___-_ _"_ _ --------------------------------- Q �1 Distance to nearest: Well----------------------------Foundaliott------- r------------------Propbo Line--,-----------------__________-----. . SEEPAGE Ph [ ] Depth..--------------Diameter--------------------Nurnlyar ---------- Rock Filled Yes ❑ No❑'(f Water Table Depth------------------------------------------ Rock Size 7, Distance to nearest: Well __.____,�„ �'' -%Founticki ____.__.Pro Cine___ - ---------- REPAIR/ADDITION (Prev. Sanitation Permit#--------------------------- ------- __ a _______ ______-- ------------------------- _ )! a Septic Tank' )(Specify Requirements)______ ___ ---___ -- _-_ _ 1 __ . i -- .1 --- Disposal Field (Specify Requirements)__ ___ ---------------------_---------------:--------------------------------- ----------- ----- . _____ __._ _____.----------- ----- ------' ------- -------- ---- �_Ve------------------------------------------------' ' -------- 1 S , i --------------------------------------------- --- ---- --- --------- - ---------------------------------I----- -------- ----------------- ------------------------ ----- -- -- (Draw existing and required adrdition on retisrseysidJe) 1 hereby certify that 1 have prepared this application and that thel work will lie"gone fnvaccordance 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: ! l "I certify that in the perfdrmance of the work for which this permit is issued, 1 shall.not employ any person in such manner as to become isub'ect to rk�f's Comp nsation laws of California." f Signed.----- `' ��AG"' --.�------- ----------------------Owner j By----- ------ ----------------------------------------------------------- ------------ -------------'--Title---------- -----------` (If other than owner) �+ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- -' . - -- -- -- ------ ---- ----------------------------------------------- ------"-------- ---r -DATE..--- `', ¢ te- -----------' DIVISION OF LAND NUMBER-------- -_-- . I •_ _ ------------ -__- ---- DATE `-- ADDITIOX COM ENTS -- �. �'" �l'-Q1' ----- --------------------- --} - ------ ------ _______ __ ________ _____ ____ -----__ _______ _______ _ r _ _ _b..._ __ __------------------------------------------------ ----- -------_ -- __--_ _ --_.- ------------------------------------------ _ _ __ -__ _ -_-_ ._-__ _-. _ ____-_-___- Final Inspection b -- - -- -- --------- - ------ ---- - ---- - Date l )r EH 13 24 SAKJOAQULN LOCAL-HEALTH NSTRICT = F4s 21677 RE 3M