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FOR OFFICE USE: - f w4 „ . V APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: ------ -------- ------_..---- - (Complete in Triplicate) Permit No...Z_��_-___/_AI '-------- - -------- --------- ------- This Permit Expires 1 Year From Date Issued Date issued-. Application .is hereby made to the San-Joaquin Local.,Heaftr,District for a permit to construct and install the work herein described. I This application is made in complianc_e7,ithCounty Ordindnce' No. 549 and existing Rules and Regulations: " JOB ADDRESS/LOCATION ----------------- ;a�W . :- _ <°__r_e =iv Owner's Name-•-- -------- G. EN TRACT T . 4 ----- - •----------- -- ----- - Address._ _ . :- --------Phone_. - ---'- ------------ -------------------- --- City.. 0-C�¢ — 1 Contractor's Name-- - / Licensehone----,---- - ;3 i Installation will serve: Residencetel Apartment House ❑ Commercial ❑ Trailer Court ❑ Number of living units:-- -- -- -- ❑ Other--- ----- Number --- �-�-- -------�-- ---=- 1 ,... g rinder_.:_------.Lot Size '�-�_r�g Supply:. ------ - -------- Watery Number of bedrooms__ .:_ Garbe e G Water Public S stem and.'name _...___ feet: Sand Silt: ------- Private p -----------.- "character of soil to a de th of 3y, ❑ t❑ Clay ❑ . Peat❑ Sandy Loam Clay Loam ❑ '� Hard 'n ❑ Adobe ❑ Fill Material.. ,1_.Ifyes, .y ws �•ktype-------- -------- ------ `[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 , it ' p permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ J SEPTIC-TANK" �' r� �' �/ f� _ ( Size -.�lV . € - - --------------Liquid Depth..------- �--- -- ...p Capacity__. /7_'?-_-_-_.Type--, . 'N67Com `artments Distance.to nearest: Well-'- ) _ ndation-. - Prop. Line -i. LEACHING LINE. Al No, of.Lines_'__-_._ ___r------- Length of.each line � i _ ,-,- ��$�--------------Total Length------- -�-0 :'D' Box..`-- - --Type Filter Material __,�,�*� epth Filter Distance to T. nearest: Well.___,. iy.- -- -.Foundatron---- __ �--------------P opertyLne-_._ -f--� 0� SEEPAGE PIT j ] s Depth.._ . :__--Diameter_? Number- ---- -_--- k_------ Rack Filled Yes —No❑ Water Table Depth-------------- ' A = ---------------Rock Size -=-:-. J� ----------------- Distance to nearest: Well,__.--_ 4,14-9-'=�_^._-----------Foundation___------_ _ ; Prop. Line---------------- ------ -- -- Se PtAi IRTanDDITION (Prev. Sanitation Permit#._ --__.-_ ------------ -----------------------Date------- Septic _- -_ p ' k (Specify Requirements)-------------,--,--- --------------------- o � Disposal Field (Specify Requirements):___________ ______ _ ----------------------------------------------------- .------- ---, -- --------- ------------------------------- --- --------I-- ------------------------------------------------------------------- ---------------------------------- ------------ a -- ------------------------- --------------------------------------------------------- ---------= {Draw existing and required addition on reverse side) ` I h reby ce ify that--I have prepared this application and-that the -work will be done in accordance ` with San Joaquin County Ordinances: State Laws, and7Aules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents .; signature certifies the following; "I Certify t`at in the � � performance"of`the work for which this permit is issued, 1 shall� not employ any person in such manner as to become.subject to..Workman's Compensation laws of California.". Signe By-' Title --- ---- -------- ------- ------------- ------------ --------- --- ---------- (If other than ow r] ✓ 4 E FOR DEPARTMENT USE ONLY` APPLICATION ACCEPTED BY-__- --- ----------- -------- = DATE. - DIVISION OF LAND NUMBER- -.- - ------ -- ----_ , - - DATE--------- ------- ADDITIONAL COMMENTS- - ----- - ----------------------------------- E --------------------------------------_---__--------_----------------- i _______--------------------------------------------------------- - sp- i -- --Y.__-_-- - = = -- .- - - --- - -- ------------------------------------------------------------ ----- -- ---- ------- ----------------- Final Inspection b = -----==--------------Date_ z --'-- P� eH 13 2a SAN JOAQUIN.LOCAL HEALTH DISTRICT res 2167 REV. 7/76' /