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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �.Y�""'•� ` �~ (Co np'Iete1in Triplicate)-fes �, Permit No._ �� S13 � 111 Date Issued--------------- 77 �-' ------ -------------------------------------------------- This Permit Expires:l 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 Co my Ordinance No. 549 and existing Rules and Regulations: _ 3 JOB ADDRESS/LOCATIO __: ___._ T ENS C Owner's Name. zxl / w Yt. --------------- ---- ------ - Phone AC7we?- - Address / 3 t -- ------ ---------- - - City ----------- ----- ZiP f�j Contractor's Name__._ _ __ __..____.____:License #__C2,714W_W_ -- Phone.:_ .__.:_._T. -- . ---- ------- -----------------_----- 41 Installation will serve: Residence [Apartment House.❑ 'Commercial ❑ Trailer Court ❑ ' C __ _ - Motel F-1 Other------- ----- '------------ ------------ --= Number of living units:_____- Number of bedroomsiGarbage Grinder____--- - Lot Size___ ___L G. /j� Water Supply: Public System and name----------------AP!, .1 = Private ❑ _ € icy Loam ❑ Clay Loam ❑ + t Hardpan ❑ Adobe❑ Fill aterial�..._.._.If Y�, tYP?` F i + Character of soil to a depth of 3 feet: Sand Silt Cla Peat Sand i f i t - , -W (Plot plan, showing size of lot, location of system in relation to wells, l�uildings,:-etc.'must be placed on reverse side.) NEW INSTALLATION: {No`septic tank"or 'seepage rlpit perm'itted'if public sewer is available within 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK [ Sizrce._`._Y___ __ g_______________________________'_Liquid Depth_,__.______________ Capacity a Type.( _ .---Material-��?�- ---------No. Compartme ts__3 ` ------------ r Distance to nearest: WelL._._ nt= -_.______ _____ _______Foundation____�� _-----------Prop. Line_..___ ___�_.___ 1 _ .`4� LEACHING LINE; { Na. of Lines.______l_________________!Length of each line__ ___ ____ ,._;___,Total_Leng.thy._.. G ........ 'D C3 Q .. i 'D' Box ----_._Type Filter Material__ : 'OWDepth Filter Material-------/2�--------------- _________ -----_-_ _------- Distance to nearest: Well. __1 -1?-! --------Foundation.......097-4------------ Line--_----1e_-------------__ _ SEEPAGE PIT [d- Depth_.- -------Diameter--------------------Number____ _ _?__ ___________ fRock Filled YesX : No ❑^ , Water. - 1J P ' Rock `Size r Table.De th - ----------=-�d-----�------------------ �.3-------------- -�------- ---- + Distance to nearest; Well___ ,'______________}_FoundatiShp- on._° ---------Prop. Line----__________-.______-_:__- REPAIR/ADDITION (PrevSanitation Permit#--'------------ -------------------------------`--.Date....-------------------------------------- , I Septic Tank (Specify Requirements) [ --------------------------------I-- -------- ------------- ----- -------------- == Disposal Field.[Specify Requirements]-_ - + ------------------------ ' R -----------------------------------------------____________________________________________________________------------______----------------------.__-----------------------.__-_---------__----- ________________ 1s _ _ i - ; (Draw existing and required addition on reverse side) + hereby certify that 1 have prepared .this application and that the work will be` done"jn 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 perFbMicante of the work for which 'this permit is issued, 1-ih`all not employ any person in such manner as Signed--'� 1-- Ow' � i E � • - - toecome 6'e to. Workman's. 'Com' pensation laws of California.nor By---------------------E/.. 4 --- Title._----------- ------ (If other than e o nr]11 FOR.'DEPARTMENT USE ONLY 3 , + r t APPLICATION ACCEPTED. BY----- - ----- --t_l f ---?2.. r -------- --------------- DATE.- DIVISION OF LAND NUMBER.------------' = - - DATE-------------- - = ADDITIONAL COMMENTS----- -------------------------------------- pk - - - ------------------------------- ] ---------------------------------------------- ------- ----- ------------- ------------- ---- 4� ` -- --- ----- ----- -- ------------------------ ---- -------------------------------=------------------- ----------------- -------------------------------------------- -- Final-inspection b — ... ..�_._ r -5_�� ,, q ,... Date.= — . � . � . EH 13 24 SAN JOAQUIN LOCAL HEALTH TR1CT Fos 21677 REV. 7/