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FOR OFFICE USE: FOR OFFICE USE: APPLICATION 11R SANITATION PERMIT _ ------------ (Complete m Trililicate} Permit No. 7.---_� --------------------------------------------------- _ Date Issued.Z�_ 7/"' --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and,install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCAT[ON.__- . .��rT__ro- _- ..., fix,/- __-__ w -� - - - - - -- ----�..-------- --------------CENSUS TRACT---------- - ------------------ Owners ----------- -Owner's Name . -- - ----- ------------------------------------------Phone.------------------------------------ Address-- -------------- --------------------Address.. `�. v" ¢_ ---------- ------------------ ---------- y. City - "3r L« Zi ---------------- Contractor's Name-------- f' f-_-�`w�/GL- � License #_�2 ,� .__Phone_ ` - - - ..___ Installation will swv'e: Residence A' artment House commercial ❑ Trailer Court Motel Other- Nu,mber ther.Number of living uni ----------- ---_Number of bedrooms------------Garbage Grinder------------Lot Size-------------------------------_--------_---_________-___-- Water Supply: Public System and name---------------------------------------- ---- ------- --- -_ -- ----- -------- ----- - --Private �. p ❑ ❑ y ❑ eat ❑ Sandy Loam ❑ Clay Loam ' .. . �Ifm es�. -e__ aracter o sol to a depth of 3 feet:' Sand -Silt Clay P 1 iardpan.❑Adobe•❑•�FilJ-lVlateric l' �.:,� Y tYP — ��-- -------------- (Plot -(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) ' ' e a e Pit P eritted ifpru b}r= -e-v- r. -dNEW INSTALLATION: (Nose tic tank or sepi e within 200 feet) Je PACKAGE TREATMENT SEPTIC TAMC Size----- 157 --- --- --------------------- -----------Liquid Depth --------------6 Ca acit .�� -----;7 e. ,ems C d P Y./ YP , ` _'' aterial--------------------------No. Compartments.... --------- -- ----.- : Foundation.- -- - 1 --� ---------- l� ---- _ -�---Prop. Line�--�? ---------p(t LEA Distance to nearest: Well..- ; ` LEACHING LINE: [.] No._of Lines._. _Length of each line'_? �___-_---__+_____Total Length. :. .._ ---------------- yp f K�. De th Filter Material_.___:___�'1..f� } , p.: 'D' Box_-.--.-- :.. T e Filter Materiel� • Barest: Well_ `rCa '...________Fouridation '__________________Property Line.. [ ] Depth----'------ :.. .. - Distance to n SEEPAGE PIT Diameter.;.`.__`____ Number:_I...__.._._.___--------------. Rock Filled Yes ❑ No ❑'� ---- Water Table Depth ` T -- -- ------ --- ------- - Rock Size"------------------------------ ------------------------{ 4 X, ----=4-----------=:--------Foundation Distance-to nearest: Wall_�---------�-- -- � Prop. Line---------------------------. REPAIR/ADDITION (Prev. Sanitation Permit#-_•----------------- I' Dat ------_--_____--___--_-- ---_----__-------) ffF t--- ptic Tank (Specify Re =_ - - --------------.� c------------------------------------- ---------- ----- P Y q uirements1 - Disposal Field (Specify Requirements) ------{------- --- - ----------; = i ---------- ------------ ------ _- = - ---- -------- -'-- ---- -- ` --------t -------------------.--- --------------------------------------------------- ------�'f -- I (Drawexisting and 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: J ti "I certify that in the performance of the work for which this permit is issued, I shall not employ yaany Yperson in.such manner as Si ned ° ensation 'laws of California.". ti �- NA g 7� n n=------ ------- --------- WAro ecome su ect to r s BY ; -----------Title------------------------- (If i other than owner) v og FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. lit/ ------- ---------- ----------------------------------------------------------DATE-----lf`Z P -'77 - DIVISION OF LAND NUMBER-------------- _..a_ . �.. _^, "----------- ADDITIONAL COMMENTS---------------------- --------- --------------------- ---------------------------- -------------------- =---- -----------------------------------------' ----------------------------------------------•--- ___ ------------------------- ---------------------------------------------------- -- --- -------------------------------- ------- _ .._...-.--.- Final Inspection°bY --- ---- - -- ------- ----------------------------= --------------------------Date...l. . ��r-77-------------- _. .EH 13 24 SAN JOA UIN LOCAL HEALTH DIS�.RICT F&S 21677 REV. 7/76 3M