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FOR OFFICE USE: - FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ �j� H Permit No.77----r- -- --- -- (Complete in Triplicate} -�------------------------- it ism 77 s Date Issued------------------- This Permit Expires----------- ------------ ---------------------' - - p s 1 Year From Date Issued •- -- ---------------'----------------_..._. _..-_...__ - - - - f d install the is hereb rrade,to the San Joaquin Lbcal HealthnDestNrot54r9and exist ng Ruiconstruct es and Regulations:work herein described. Application Y This applycation is made in compliance with County Ordina 0.- This4 _ - ----- .CEN_SU-S TRACT- RACT- --------------- ---------- �- JOB ADDRESS/LOCATION .--7- ` :� " Phone-------------------------------------- ---------- C .._------------ ---=------ _-. - "^ » d-------- ---- ------ rW Q - CitY- . P' + _Owner's Name - t_ ? .---- ---- Ph ne 0 Ad ------ --------- dress ------ --------- - nse #Lie Contractor's Name--------- Commercial ❑ Trailer Court ❑ Residence Ap House.❑ Installation will serve: artmpnt ----- f - Motel ❑ Other-------------------------------- ------ ------- 5 - [ - -- ---- . Z i iw - r Private ber of living units:---- - -Number of bedrooms.--"---�---Garbage Grinder.------"-=--Lot Size_-�0-�--�-�� ....... ---_-- Num0-�- : y�p� ❑ _ -Pu r -------------- Water Supp�y Pub11c•System and name peat ❑ S dy Loam ❑ Clay Loam. i - Character of soil to a depth of 3 feet: #_-Sand ❑. „Silt❑ Clay ❑ f Hardpan ❑ Adobe� Fill Material------------1f Yes, type-,- ------- ----- - ---- -- ced n reverse �-«� {plot plan, showing size of lot,location of system in relation �mwttedellsif ptiblicge\der is available wi hon 200 feet,} e �� NEW INSTALLATION: , {No'-septic tank_or seepage pit pe , �•. ------------Liquid Depth Z_V.,e Size_ - - ±-.-'---::---- - " - -- - SEPTIC TANK ` ____-- PACKAGE TREATMENT [ } C Matariaf f -No compartments.-- --------- ei ' Capacity-1.1 -OO-_- -"i YP ` ' ' I Pro Line-_ ------------- o�1.0 { Foundation.- p` Q - = - 1 Distance to nearest: We11.. --- Total Length ------- - ------- -------------- No, of Lines `�t'F ----�---- Length of each, line' - �- ,p LEACHING LINE b< -f-�'1- --------- ---- f D' Box,-.--/--Type Filter Material_.- ____!_._- _ .Depth Filter Material_-" ____ ___ ___ __ __ f S Distance to nearest: Well. G=------', 'Foundation--._�- - 10 Property Line-------------es Rock Filled Yes No [Ab .r t ��, Diameter. Number Z a[ SEEPAGE PIT _ Depth-.Z-S } .Water Table Depth----'---- ' --------- Rock Size= _ 7 Gt,la;,--�--------------Foundation--- ---- --------------Prop. Line ---�`-�---- ----. -- il Distance to nearbst--�Wel1._-.- - �. " ------------------ - -------------.Date. REPAIR/ADDITION (Prev. Sanitation Permit#-------' t —i`�.. r ---- '------------------------------------------------------ Se -------------------------------------------- Setic Tank (Specify Requirements) ------- Ilk- ---------- -------- ------------------------ p ' �- Disposal Field (Specify Require nts)-'- -. .__. -��r�+.. 5 ------------------------- ----------------------- - -- ---------------------- ------- ' _ ----------- ----------- -- - �. - reverse.si e) (Draw existing and required addition on Joaquin County I hereby certify that I have prepared this application and that the work:will be done in accordance with San J is agents ordinances, State Laws, and Rules and 'Regulations of the San Joaquin Local Health District. Home owner or license signature certifies the following: to an person in such manner as �yy thaf`'in the performance of the work for which this permit is issued, i shall not employ Y to become subiect arkma 's Co ensation Iaws�pf California." NNW �- Signed --- .Title-- t r �i --�------ -------- � T liy (lf'other thonaowner FOR DEPARTMENT USE ONLY ----------DATE.-./ yr= 7 ?------- ------ ------------------ APPLICATION ACCEPTED BY - .DATE. ----� - ------------------------------ DIVISION OF LAND NUMBER. '= ,a _ = R - --------------- --- ------- ADDITIONAL COMMENTS------------------------------------------------------- -------------------------------------- --- ----- - -- ----------------= ----------------- D ate_ r --- ----------------------------- i' ,c - --- •----" F&S 21677 REV. 7176 3� Final Inspection by:--------,--- 1N•LOCAL ALT DISTRICT EH 13 24 SAN JO