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FOR OFFICE USE: 'FOR ONCE USE: APPLICATION FOR SANITATION PERMIT ; Permit No._7-.�-"--3--�--•� (CompleWin Triplicate) Date Issuedy-C_'_?. -"-. This Permit Expires 1 Year From Date Issued . ----------- p consruct and install - Application is hereby made to the San Joaquin Lnty OHredintanccesNo. 549 and existing Rul to #es and Regulations. work herein described. This application is made in compliance with County _ �'`-�-` X� 1 _.._ <-` �- "" C.ENSUS.TRACT JOB ADDRESS/LOCATION - -- p --_ - --- -'- _ _ ------------------------- ---------------- Owner's --- -'---" ------ -- - - -- ------ Phone Owner's Name------------------�._�.�.�---- --'--��--�--- -��-- --'- - - S ' _ - ------------ ; Address---- ------------ City- ti� _ .. .Phone_ ---------------- Contractor's - -- --- - Z. -_(�_�!1_. - °--------- ----- -----------------------License #_, .._ . _ _ f j Cantrac#or's Narne____________________� --� Installation will serve: Residence Apartment House E] Commercial ❑ Tra ller Court ❑ Motel ❑ Other------- -- -------------------------- --- --- rT— --. I Number of living units:-----/-----__Number of bedrooms_-�------Garbage Grinder_IZi -Lot Size___._-.___""--- - P t ---------------------------- riva ed� --------------z:--------- - r Water Supply: Public System and name----------- ClLoam Character of soil to a depth of 3 feet: Sand LJ Silt ❑ Clay El Peat ElSandy Loam ❑ a Y 1 Adobe Fill Material_._--"- _"-lftpetc. must be ""-L--" -" l Hardpan ❑ '❑ (Plot plan, showing size of lot, location of sys4em in relation to wells, buildings, placed on reverse side.) } 0 NEW INSTALLATION: (No septic to or seepage pit permitted if public sewer is available within 200 feet,) N - PACKAGE TREATMENT [' l I) Size- ------ --------------- ------------ Liquid Depfih l ; SEPTIC TANK [ No. Com artments----------------------`------- Ca acit (Type---------------- Material------------------------ p Pro Line------------- 'Distance ----•------ = Distanceto nearest: Well------------_".------------ _ Foundation----------------------- p• 1 ----.:Len th of each line---- -------- ----=-- ----'- .Total Lengfih-----------------------------:�------- I LEACHING LINE [ ] No. of Lines T- •------ . g ! -- I-------- .,, r . . .Type rial-- ----"- -�-----Depth Filter Material ----'--- -------------- ------- --- - - - - f__ - f e .4.... 4 .P. n... - il.. ..a- k S . Property Line------------- - - to nearest: Well.____- D Box---- . e Fi•ter . a e -Foundation---------------------------- Distance, - - P ock Filled Ye t •- "�r �.-------Diameter " Number = R No❑ SEEPAGE PIT [ 1 P t De th._.-___,- - -- - -------'Rock Size-----------'==-`•-'--------------------------- Water ----- - + Water Table '.Depth._-'--- ----------------------------------- - - Distance'to nearest: Well-':-------------.--'--- = Foundatiori_`------------------ -.Prop. Line-------- -= )_r_ ____- _ = : -ate-------------- - ---------- � REPAIR/ADDITION (Prev. Sanitation Permit#_._. _-- - M f,. J ' ________ = __ D = - =------- - _.._ '-Septic Tank (Specify Requirements)_ _ _2 7 -------- Disposal 11 Disposal Field.(Specify Requiremes .__________ _ ` --- ---- -------- -- --------------- --- - -------- - -- -- -- - -- --•---- ---- --------------------------''----'---___ ff if C-Al -_(DrJ existing and required addition on reverse side) Y +: l hereby certify that 1 have prepared this application and that the work will be done i1.n accordance=with, San Joaquin}County Ordinances, State Laws, and Rules "and Regulations of the: San Joaquin Local Ith�istricf Home owner or licensed agents signature certifies the following: 'r { erson in such imanner as "i certify that in the performance of'tlie.work for which this permit is issued,�.l shall not emp o�ny pl � � to became subject to Workman's Compenscition laws of California ', . _-------------'- 0. T ! sr -------------- Signe -- ' -- ------- --- . . __Title ---'- -------' --- BY------------------------------------:----- ---------' `, r (If other than owner) '. .f s R DEPARTME T USE ONLY I DATE. ` E' APPLICATION ACCEPTED BY --�'�✓ --- -- - - i �, 3 ti. DATE __-------------- ------- .. -- E. I DIVISION OF LAND NUMBER._ �.. ------- - --------------' - ,� , ----------------------------- ------- f ADDITIONAL COMMENTS sf' " -------=- ------ ------ = ------------------ _ = - ' --------- ------ - 1 '-- t ------------- = ' F G ---- ____-_•______ _ __ __ __ _ _____________ y __________________________________ or _______-__ - __ v -- '- --- -- - -- --- " _____ ------- ------- ------- ----"''}Dai -- -- -� Cts-.r �` Final Inspection b - - ""-"""- ----- t y---------- --- F&5 21677 REV. 7/76 3M ' SAN JO QUIN LOCAL HEALTH DISTRICT � t 1c rte- EH 13 24 L " 1� 0� C It