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k' FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------------------------------------- (Complete in Triplicate) Permit No,___ -----------------7-^ 776- --------------- --------- -------------- Date Issued.._ a ' 7? j --------- -- 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 This application is made in complia� with County Ordinance No, 549.and.existing-Rules<and:Regulations: described. JOB ADDRESS/LOCATION ___ ff} 4550/Y �j 4- A." 1 -- --------------- --- ---�QrT"--- i3 ------. - ---.CENSUS TRACT-- Z`-tl_--r(,0_02— Owner's Name.--- ----�s`-L_ i/,P.;A4 - 3 - t . :_.. ----- - -- ---- . -----j - --- _.Phone__ - Address / a� ..rfflE� --- - Cidi 1 I �-- f --- Zip ---------------------------- Contractor's Name_..__ _.I N�`1alVy { alb -----License #16� -----------------Ie Phone •4�-F �'�/✓ t ------ - Instalfation,will serve: Residence ❑ Apartment House ❑ Commercial J -Tra-ler Court ❑ - Motel ❑ Other_ T�r« - . Qis]'xAvirj' Number of living units--------_---------Number of.bed rooms------------Garbage Grinde --------..___L-ot Size--- __�"___�C-?'�✓ t � " a Water Supply: Public System and name _---- ------- -------------------------- E' ` �'� r `= ; - ----------Private.;Ki Character of soil to a depth of 3 feet: ` Sand C] ;Silt❑ Clay ❑ NPeat 0 Sandy Loam M ,Clay Loam E]. I Hardpan ❑ Adobe L] Fill Material _.--__....If#yes, type------ -------------- (Plot plan showing - F g size of lot, location of system in relation to wells, buildingsetc. must beplaced!on reverse side,) NEW INSTALLATION:'" INo,septic tank" r seepage ;pit permitted if plic sewer is available within 200#feet,} { PACKAGE TREATMENT Ca Pa" cSitEYP3TI.0atT9AoN. K> .. ----G-,--A•Ssiz1e"- --- --- ---- - _Gv''r►re %. Co_mpkaLri tmueidn{tsD-e---- t 14 ,TYpe ! Material Distance to nearest: Wei —p—line 47 -- --;-_ - --. re ------.--R 1r LEACHING LINE [ ] No. of Lines.--.-.----` ----- ---------- Length of each fin&._ /0O_'--:---- 0 TotaI Length._ J�6 ---- 'D' Box_ : .Type Filter Material yyceC f--__Depth Filter Matenaf =s _C' �� ! r "Distance to nearest: Well �� --- Foundations?' ` .Property Line._<�' � , -47 a,.. . SEEPAGE PIT 1 Depth ------------ _...y 7 f' s p. .- ---- ---Diameter : ._ -_ Number r,• --- "--- ---- ''Roc Filled Ye ❑ N _ k . s o❑ + Water Table.Depth---F------- ------------=---.-,-----------------: - Rock Size-- --- ? Well r ------------------ Distance to nearest: .--_.__-- -,- -4�F-------------#-,--,Foundation-_____--- -------------- Prop. Line---_-------------- ./� .�.. /ADDITION IPrev. Sanitation Permit#:.._ _.-_-- __ T-------- Date- OUR Septic Tank (Specify Requirements)-. = ---- ` "-- =---------------- ------ --------------------------------------- Disposal Field (Specify:Requirementsj----t---._i� :: - _ ------------ ------------------------------------------------------------- --------------------------- .�' .... ---. rW - ----=----------------------------- -- ------------- ------------- = - ;-- - ------ - (Draw existin e uireEladdition"on r'eyer,--- 9and r f� q �sede) _si 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 Ruies•and Regulatio s of the San Joaquin Lo[I Health District; Home owner or licensed agents signature certifies the following:" "I certify that in the performance ofahe work"foi which this permit is 1ssued,'64halh;not employ;any Signed_s_g 3 person in such manner as to become subject to Workman's Compensation ..laws .of California." '? i 1 -L; } -._: -------------------- ---------- ---- ----------- - -------- -Owner I -o hon"owner} .. . . ----- •---------------------- it e FOR PART \------------ M NT USE ONLY. , APPLICATION ACCEPTED BY__. _ _ ------- - --- --------- ---------------- -- �r ._DA DIVISION OF LAND NUMBER.-.---- --_--- -- ------ --------------------- -------- - DATE TE --- ADDITIONAL COMMENTS____________________ ------ -----------------. , ------------>-----=------------ _j --------------- -- ----------- --- ---- --- ---- Final-lnPs ection-bY' p t .... EH 13 24 . r k`� 7 74 3M SAN JOAQUIN LOCAL HEALTH QISTRICT r&s 21F<