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!� FOR OFFICE USE: FOR OFFICE USE: T ' APPLICATION.FOR SANITAMOh._ERMIT p Permit (Complete in Triplicate) _ --------------------- ----------------------------------- Date Issued_6_._/o"-77 This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District fora perrr;it to construct and install the work herein described. F This application is made in compliance with County Ordinance No. 349,and existing Rules.and Regulations J� JOB ADDRESS/LOCATION-_. OCATION -- --- � �'1--- ---� -- - ----- �_ - K-------------- - --------- ------------- CENSUS - TRACT.-- ------- -------------------- Owner's Name.--- - - - -� - - ---- -----= -------- ----- ---- --- ---- ---- -- - ----------- - a --------Phone--------------- ---------------------- ` C ---- Zip Address- ---------- --- ---- ------ ---------- --- ----- y Contractor's Name_____ .License #_ i --0 k �._Phone � ` F Installation will serve: Residence d,-"Apartment House.❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other- ----.-----_. _ j s € ef'47' ----------- Number of living units:- --_-_-_Number of bedrooms:_._.Garbage Grinder_..--._____Lot Size-_-. a ^ • ❑ Water Supply: Public System and name- _----- e W -- - Private Character of soil to a depth of 3 feet: ' Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy LoamEl Clay Loam Hardpan ❑ Adobe ❑ Fill Material_- ---------If yes,type- ----------- -- ---------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) f NEW INSTALLATION: (No septic tank or seepage pit permitted if-p+yblic sewer is available within 200 feet,] ' it s Size--- p- Liquid Depth ------------------------- PACKAGE TREATMENT L ] SEPTIC TANK ,[�] �. � •�, � �- �-----�---�--- - -- ---- ---- C' ' ` < No. Compartments apathy--1.x_0 P-=- Type---.---- -- Material P 6 , ------------Pro Line---- `�-p---- ------- F � Foundation----�'U_ p• f � Distance to nearest: Well__._____..___,_ -�-- --------------- LEACHING LINE I l Na. of Lines:_k � -� `_'`"Lengthof each line.--------- - ------- --.Total Length._--- '- ---------------------------- 'D' Box------------Type Filter Material------- --Depth Filter Material----- - -------------------------- �- - L ' / aDistance to nearest: Well_-.1-�.� Foundat.ion___ v-_-____.-- -.Property L'+ne__�-�G�- De th_ 1_/_.�_tiaeter-- Nu -- Depth-AX/ :.,, ..-,.. ? tuber W - ___ ? Rock Filled Yes No ,�F�PAG�--PIT E l P, --�-- Water Table'Depth----------------------------- -`---Rock Size { k Distance to nearest: Well /6-� --Foundation--------------------------Prop. Line----- --------- ------- REPAIR/ADDITION-(Prev. Sanitation Permit#--------------------------------- -------------- -Date---------------------------------------------- ] . i Septic Tank (specify Requirements ------------=------------------- ------------ -- - --------- Disposal Field (Specify Requirements)------------ _--------- ----------------------=--- --------------------------- ----------------- ----------------------------- ---------------------- ------------- ------ -------- --------------------------------- --------- ----------------------------- ---- q ------------- --------------- (Draw existingand required addition on reverse side) i 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: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." -"wnar Signed -- _ - - ' �Y r -- itle------------ ---------------------------------------------------------_ - - (I ot-h t an�owrier] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- - - ------------------------------------------- DATE...i'"/LS :7 ------ DATE ---------- - ---------------------------------- DIVISION OF LAND NUMBER-------------- --- - ---- ----------: ------------------------ ADDITIONAL COMMENTS------------------ ---------------------- ----------------------- -- ------------------------------------------ ------------------------------------- -- - ----- ------------ ----------- ------------------ - --- ----------------------------------- ---- ----�------------------------ ---------------- - ----- ---Date. - --- ----- ------- ----------------- Final inspection by:--- F&5 21677 REV. 7176 3M ------------ --- -- - ------ - -- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT