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#FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: 1 ----------------------------------------------------- d (Complete in Triplicate) Permit No._'7 --- ------------------------ ---------- .max. Date Issued__/!__R-/7' 7 7 """ ---- - ,.-This•Permit Expires 1 ,Year.From date issuedfi , "-" Application is hereby made to the San Joaquin Local'Heaith District for a permit to`onstruct and-.install the work herein described. This application is made in compliance with County Ordinance No. 549:and exi 'ng Rules and Regulations:_ JOB ADDRESS/LOCATION------------ --- - � � �.,-- t E T� � p = Com- . - - __ .�.:_ C NSU5 TRACT Owner's Name.--- -- ` 4-_ S ` Address---- 3 _. on ------- } ----- _ °C Contractor s Name___.___ .. _______ -- License = �;�, hone �Q rP --------- Installation,will serve: i Residence partment House.❑ Commercial ❑ �Trailer Court ❑ t .. _ .. Morel ❑ Other._rt ---------� _•_:.-- ---=------- = ] F I Number of living-units: '_____Number-of_ b'm 'r •-.____Garbo e.Grinder._ Lot-Lot.. _.� [1 ' ,� tc Water Supply: Public System and name-- .__-__ 11-" _ __ [ --- Private '❑ �� Character of soil'to a depth of 3 feet: Sand Silt [ t._ ❑ E y ❑ Peat 0 Sandy Loam ❑ ICI-ay Loam ❑ P ❑ ❑ - , !{ a.f V --------- ------------------' 3 t [ Hard Adobe Fill Material_.. _, If ye's type_ (Plot planshowing size of lot, location of system in relati on to wells, bOrldings„etc.must be(placed on reverse side.) NEW INSTALLATION: '(No se' is tank or seepageFprt permwe itted if public'ser is available mdithin 200 feet,) e PACKAGE-TREATMENT SiEPTIC TNKSi2e ------------ w Ph.------------------------ --- -- --- --- :� _ --------:Type ----`. =--� _ . a. .. � �P L'qu�d Det . -- = :Material . :-- -- ------- ----_-No Com artments ---------------------------- .. Distance;to nearest: Wella.--=--' >-- ------------------ -„_ Foundation.-'----- --,--=i_.- 1 = ----- Prop. Line-------- --- q LEACHING LINE” _ F ! 5 f,.] -. NDo.BO of. Filter Matereagth of each Eipne Depth Filter Materialotal-Length.__.__,___-_.____-___ __-------------- e �.+-a.-...-sa-•s�e�.o - .a�._ -----^ -p- - - --------- ----------- ---- to nearest: Well__------ ------------- -Foundation_.- .___-Y [ l Deth Distance,'.. . • - --- -' e-----------------------=---- - T 1. arty Lin - r SEEPAGE PIT Number-------------- ------ Rock Fil€ed Yes❑ No t -Vl/ater Table DeDthmeter_=:.' P --- ---- P --------- - t --------_.Rock -. k € ----- ---- , .•Distance.to nearest:'Well------------ V - _ Foundation � � t l i •• i � Prop, Line -----A REPAIR/ADDITION (Prey-San•itatian-Perm`it#: -------------------- D�_T �p . ---- - -- ---- �--- �------- r Y, Septic Tank (Specify Reg0irements)~°____,_ :- W�_ !_ -------- Disposal Field (Specify egyirements)_--- I ,_/- - }” - - -----,------ '• _-- __ - --- s _.... _---____________________.____""_______. S _- / (DraW�existirig and required addition.on reverse side) i t�I hereby certify that'l 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 D€stric#, Home owner or licensed a ents signature certifies the Bowing : g "I cern that in 'the r—' i _ certify performance of the work for which this permit is issued, I*shall no# employ any person in such manner as to become subject to Workman's,Compensation laws of California." "b" Signed . < - :: --- - -Ow` nerj-----=------- BY ,.- - ---- Title_ r _ ." � i _ (I o er than.owner) l ,. F r l ° FORrDEPARTMENT USE ONLY' x F APPLICATION ACCEPTED BY. �--a.•!� ---==-----#-1 -------------------- -- DATE - -y '7---- -- DIVISION OF LAND NUMBER.___.____-- - --- - ------ :------------------------- DATE.------- --- -------------- t ADDITIONAL COMMENTS_-___._____-_--_.._ _ t . --- - --- ------------------ -""---. - " '_- - - - -------------------------- --------------------- ----------------------------------------------- - - . I Final - ------------------------ ------------ --------- Inspection by: i -- bate_.. _.__G_._- EH 13 24 "^�•SAN�JOAQl1IN LO�EALTH DIS Fos 21677 v. 7 7'