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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No.._7_�-:.�9l� i /' - Date Issued--'7-._'.-- _4r --..------- 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 described. This application is made in compliance with County Ourdjpynce No. 549 and existing Rules and Regulations: t JOB ADDRESS/LOOT DN_,__ , E lSTR___._._ ---- ------ Y -------- ------ _ ACT_/.Owner's CV ►� ---------------------- Phone Com ` Address--- 56.77 =' -------------- _t.... ----- - --- --- ------ - -- -------- - �} City --- - Zip. �. Contractor's Name----- --- - p(aX57.2 ------------------------ License --------Phone.. -�------------------- Installation will serve: Residence Apartment. House ❑ Commercial ❑T Trailer Court ❑ i .._. Motel ❑ Other------ Number .of ---Number.of living units:-------- _Number of bedrooms;.,__Garbage Grinder:,-__.----_-Lot Size___- S ._ Wdter Supply: Public System and name__ -____ _ _. --------- --------------- P ---- :--... ----------------------------------------- Character ofsoil to a depth of 3 feet: Sand ❑ Silt❑ ,Clay ❑ Peat❑ Sandy Loam 8-`Clay Loam ❑ ` Hardan Adobe Fill 1 If yes, type-------------------- ' Materia (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 sewer is available within 200 feet,M ' PACKAGE TREATMENT [ ] =SEPTIC TANK [e4— Size -- 7 _� Liquid Depth-_5- .r ------ Ca pacity. ----Capacity- _Type --- - :Material-.... =`-:_`_No. Compartments-- # r , ante to nearest: WeIL---------- - ---- - �3 Dist g f _:_.Foundation :-°° ` Prop. Line_f_-Zd------ -= LEACHING LINE [ No, of Lines 2-_ . Len th,of �a -h line----- _ Total Lf n DO,� D Box- ._. .Type Filter Material/,e&. _,_ e th Filter Material______..__1.___ r .. -- ;-- ------ ---� P �. _ Distance to nearest: Well __ r!_f. ------------Foundation...._ a----------------- p eVl a SEEPAGE PIT z ��, t� n ' Property Lin - 4 [�] Depth_.__ 57__Diameter --_-" .- .-Number________________________._.__ R �k Filled >Yes No E] Water Table Depth------- ---'-------------- --`: -----------------Roc Size=_ Distance to nearest: Well_:':` 1 i------ -----5 . -5 {-- -------- :-.Pr,... � , I T � -Foundation__1op -------- Distance REPAIR/ADDITION (Prev. Sanitation Permit#--------------- --- --------i __ ----- ""--.Date----------:-- -- , ---------------- __-- _ i Septic Tank (Specify Requirements)___________________ ✓ ," _ _ k l _ ------------------------------_------------------------------------- I r. Disposal Field (Specify Requ.irements)----------- -- --_--------------4 *fA' +_ - ---------------------- ----------------=------- -- ---- ---------------------- i ------------------ ------------ ----- ----------------- .-_------------- i d addition. Draw existing and-requ' ------------ --- -------------------------- J __ _ _ -_ ____ .................................. ( ,on reverse side) 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 Rules and Regulations- of",the San`Joaquin Local Health District, Home owner or licensed agents signature certifies the following: 4 "I certifythat in the I�• ` performance of.fh6`work for which this permit�is issued, I'shall not employ any person in'such manner as to become subject Workman'11compensation laws. of California." . .. t Sig ned_ ---- ----------- ------- ----- - --------------` �------�wer By - - - ---- ---- -- ------------------- ie �-,eij 4A�-- - , --- ------------- (If other than'.owner) FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY--- ----- ----- ------- ---='_ ` . DATE - DIVISION ,r.� OF LAND NUMBER: '---------- ----------- --------------DA T ----- ------------------------ --- ADDITIONAL COMMENTS - -� .-_:_-----='------ ------.--------------------------------- - - -------------------------------------------------------- - - -----------•-------- - -- -------------------------------------- ---- --- ----- ---- -- ----------- -------- ----- --------- - -------- ----- - - --------------------- - ---------------•-------------- -------------- Final Inspection by:_--"` = __Date: - -- ------------- ------------- ------------ ------------ -- - ------- ---- EH 13 24 SAN JOA IN LOCAL HEALTH DISTRICT F&s 21677 Rev. 7/76 3M �.