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I FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: S-s3 -------30------------------------ ----- Permit No.7- -(Complete in Triplicate) --- -- _�_[--- ---------------------- ------ } Date lssued7_—�/--:-2�/ �--------------- ------- ---------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquinf Local Ith District for a permit to co sfiruct and install the work herein described. This application is made in compliance with County r inance No. 549 and existing Rules and Regulations:� !OB ADDRESS/LOCATIO .71 -------- - - -.CENSUS TRACT --- -. F Owner s Name.'. = = = i : . ° _ _ rA7S ---f------- _ ---- ------ . - ---------F----ne---Zip------------------ Address ` License #, �� Ph e- - . - ' rx,(Ar� c� n Contractor's Name _`_�. t --- -f'-------- 0 Installation will. serve: Residence,4 Apartment House.❑ Commercial ❑ -Trailer Court, ❑ ? f Motel ❑ ,Other -- -------= ------ -- I N amber of living units: �_.-___.._Number of bedrooms i_ Garbage Grimm_____ Lot,Size -- Water Supply: Public System and name----"------------=-----'--'-- --- Private ❑ C: Character of soil to a depth of 3 feet: ---- Sand ❑ Silt ❑ Clay ❑ Peat❑ S ndy Loa ❑ Clay Loam # Hardpan-❑ i Adobe Fill Materi.a•L..._:_..._..J.f_y-es,type_____j__--_}_:___- t (Plot plan, showing size of lot, location of system in relation to-wells, buildings, etc. must be placed o reverse side.) NEW INSTALLAT[ON: (No septic tank or seepage pit permitted if public sewer is ova lnble within 200 feet,) $ �" e PACKAGE TREATMENTA; SEPTIC TANK c[] ...._. .--'-'Size-------------:--------- =-----;- £ -t - ,-- Liquid Depth.--------- -----------8--- [ } I £. D stance .ta nearest: Well Material:__----------- o:�Compatments p' Y :.Type ti ------Foundation.--[---- } Prop. Line ------------=-------------- • iI : -+C] LEACHING LINE, [. 1 No. 'of Lines. = = Length.of.each.line:= :5--------7 I Length -------------------- = rb --- .. � --------------------... l ------ -- ------ ------ ----- Depth Filter Mater) h D Box__ .___Type 1=i•Iter Material , p f � � • - ' � "- . ._. Number-%4y Distance to nearest Well__ ` _.Foundation-._ -Property Line--------------------- r --- SEEPAGE PIT [ eptly---- QEameter ----_. ! i -_ - �`� ' ` r° a Rock Filled Yes.O No . s --- ----------- R S e ---------------------- W. .- .,� �._.... ... ....................... z ._ Water Table°Depth " I #. AN R.. ; Distance to nearest:Well'----_.-- --------------------- Foundation--- ------------ ' Prop. Line -.--- - . + r � .•may`: � ;{. _ _ REPAIR/ADDITION (Prev. Sanitation Perm --------- =--=---- ---------Date ;_- -_.-- } Tank (Specify Requirements)-- :::_:._:_� -= ----------- # -------- ' Disposal Field (Specify Requirements}.. --------------------- --" - -� ----- -------- -- ------------------------------------ -------- -----------.. -------------------- ------------ ------ C -'L-rte'"-------- ------ +� E ----------------------------- ----'---------------------------.-------.------ --------------------------------- a, {Draw existing grid required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with San JoaquinCounty ' Ordinances, State Laws, and Rules and Regulations o the San_ JoAuin Local Health District, Home owner or licensed agents signature certifies the fallowing: a "I certify that in the pe - � ance�of'the.work for which this permit is issued, I shall not employ any person in such manner as me-subject to man's Compensci laws of Ca fornia.'b to beco } or 1 � � � • Signed---- .....a. -- ------- ~ ----. .---- - - ------------------------ ------- ----- -- 41 BY _.:__. ---- _-Tit ---- ~ T e F i (If other than ovine 4 -F EPA MENT USE ONLY APPLICATION ACCEPTED BY--------- -- = - _ ---- DATE------7111-:77- -------= _ - DIVISION OF LAND NUMBER---------------------------------------------- =------------ DATE - ADDITIONAL COMMENTS--------r --------------�� --------- �-�'� '` f ;. ------ ----�-------------- ------- ----- - ----- -- ------ ---------------- --r .. _ --=---Date. Final Inspection b - '.�`"� ----- ---------- ------------------ ----------------------------- EH 13 24 S N JOAQUIN LOCAL HEALTH DISTRICT Eos 21677 Rev. 7176 3rn