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FOR OFFICE USE: ) C FOR OFFICE USE: 1 %APPLICATION FOR SANITATION PERMIT L� t•p----------- ---11- 7+�I1--------fes--- Permit No.-77_`.7--- - { " {Complete in Triplicate} ------------------------ --------- 6-� . � �/J4//L Date Issued__ ------------------ "---------------- . �_-__ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaqui LocditHeaLth,%D!stricf-f:or a-permit to construct and install the work herein described. This aliance with Coun pplication_is made iri compfiy Ordinance No. 54.9 dnd existing Rules and Regulations: I ` rz JOB ADDRESS/LOCATION.i�/lv- -----,.J- --. 27 ' --- - i,-- CENSUS TRACT•,_Q�---------------- ---- *- t f � ltfl'1 ✓�.Owners Name 4 �N------------ Address Address--------------------�/ � ----- -------------- --- - -Ci tY---- . - �P_ -a--n--e- -'Zip-------------------------- ---------------- ---- -- ------------ License #- Phone Namee - Installation will- serve: ResidenceXteApart enhe ouse-❑ -Commercial ❑V `Trailer Court ❑ Number of living units: of,of.bedroo❑ms . _ =Ga`rbage Grinder�_,_Lot Size____-_ -I - ,--•- } Water Supply: Public System and name_-',.:. ------------------------------------------------------------------------- `-------------- ---- -_- _- ------Private� Character of soil to a depth of 3 feet: Sand 0 SiltlE atela'y-D; Peift❑ t Sandy Loa "Clay Loam 0 s- m_Hardpan ❑tl Adobe ❑ y Yp f . r s buildings etc'must be placed on reverse side.) (Plot plan, showing size of lot, to ationof system in relation to wells, NEW INSTALLATION:""_!(No septic tank--or seeppge .pit 'permitted if public s` ewer is available within 200 feetj' ' i PACKAGE TREATMENT { ] SEPTIC TANK![] Sixe 't- l��'sy`--.- f-` `------k ---Liquid Depth ___._... _� 4 Capacity --"- --- -Type-- Mateial �' r:__-- -No:Compartments ------- ` Distance`.to nearest: Well.-__"_ ___ ____.. Prop. Line .. ------------------- ------ ---- -- ---- . LEACHING LINE ['] No. of Li-nes,.......... _-__ _.'��. Ler h•of-eac [ � : h lints -- Total Length}.=_. M _ _ : , Wr �"`-' ° ___De Depth Filter Material----------------------------------------------------------- _ 'D Box ;__Type Fil�erMatenal .. -`�..a `�tom]-- .. . __ p ..t - L. ' �� s Distance to nearest: , ell_ s;___ - koundatlon---------- ------------ Property Line-------------------------------""-- SEEPAGE PIT [ ] Depth----------- Diart�eter ° _ Number___ ' ____ _ Rock Filled ' Yes ❑ No❑ Water Table:Dept =' _ = = ':.__.Rock Size------------------------------------------- h F i Distance"to nearest: Well ,< � r- oundation _______ Prop. Line REPAIR/ADDITION (Prew'Sanitation -- -----------r_ __ . ;—'►D--aytame,.. --Z ----- - ---.---------- ----- -----" Septic Tank (Specify Requirements)- --" A } --------- - " ti , -[' a '�i . --------- ----- ---------Disposal Field (Specify Requirements) ------------------ ! - ----- ------- _- - ------_--_ --- ---- ------------------------ -- --t - -- - -----`--- ------------ ------------------- - -- -- (brbw existing' and re uiredaddition on reverse side) I hereby certify that I have prepared-this•application and that:the -work will-be done in accordance�wiith San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Sari 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 bece- s I�e-c-t to- W- or an s Com ens.atiom'-. la:ws o:f. California." - -k-- ------------------ -- -- --- :--_--� , -----=OwnOwner_ Signed_ . .. ' . . . - -. t 'Title± -------------- - BY -------------------- --- ----=----------. v. [ { other than owner) > # FOR DEPARTMENT USE ONLY ' // Q APPLICATION ACCEPTED BY---------- --lf ------ - `---;=-- - --r✓-0__,Z----�fa ---------DATE (----------------- DIVISIONOF LAND NUMBER-- ------------- ------------------- - ------------------ -------------------------------------------- ----- DATE.------------------ ------------------- ---- ADDITIONALCOMMENTS- --------- ------------ ------------ `-------------°------ --------------------------:--------------------- ----------- --------------- ------------------------ * - -- -- ----- ----- --------------------------- -------------------------•---, ----------------- ----------------------------------- Y` T ' - ---------------------------------- - - - ----------------------------- ---- � -- ------------------ --------------_-- ---- -- Final Inspection by:_.X;-__ 4 ------- -``"` `` _ _ _------DateAr�=/7--77-------- ----------------- - . EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT f&3 21677 REV. 7/76 3M