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FOR OFFICE USE: FOR OFFICE USE: - APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No,?r1n,1j.S__,1 --------------------------------------- ----------------- ............... This Permit Expires 1 Year From Date Issued 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/LOCATION--/"f.7 . ..................... .......CENSUS TRACT--------------- Owner's Name.... R, L.._..._«G,G.I..TT Address . .._.._.X10 l i ------------ ---- ---- --- ----- - - ------ City----------------- ........................-Zip--------------- ------ Contractor's Name......../ ,oe................... . . .............:.......License #..�_ I-- ,� a�..Phone-_7772----A.70. Installation will serve: ResidenceApartment House E] Commercial F1 Trailer Court ❑ Cel ❑ Other.... . r Number of living units:....1---------Number of bedrooms_.._ Garbage Grinder. _...Lot Water Supply: Public System and name_. .. ._ ---�f,,g --- ........... Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy loam Clay Loam [; Hardpan ❑ Adobe Q< Fill Material.. .... ....If yes, type----------------------- (Plot ___________________ __(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 4 PACKAGE TREATMENT [ ] SEP. I TA K ] Size / - -- - -----------------------------------------.-Liquid Depth....---------------------.- Capacity P Y .- TYPe+ f .1�klLiMaterial.-LG�M17 �._..No. Compartments-....Z -------------------------12\ Distance o nea est: Well----- ....... ...... . . ---......Foundation... /W........ .. Prop. Line LEACHING LINE [ ] Na. of Li es . - __..Length of each line.... _.__..._.Tota! Length .. .._.y'�.QQ.................... 'D' Box pe Filter Material ��ff , Inp a th Filter Material........ ... ... ........ t s•4fy�� Distance to n,/ea4e�t: Well...,e(1, .r... . _ __-__.Foundation.___.�QE '_......._Property Line._-_-S..'f"...........------- SEEP ....... ��AGE PIT [ ] DepthI- le 10 iameter----�GJ - ...Number.....�-_.-___------------- Rock Filled Ye I-V No ❑ p ----------------- --------- - -------------------- -- ,l.l-J`t., l�i o4c. Water T D th.___ - Rock 5ize._ e Distance o neo st: Well----------V/�_---- -------------------Foundation.- /10....'t`........Prop. Line---- - REPAIR/ADDITION {Prev. Sanitati Per 1 4—� ............Date---__.--_--____._._. ) --------- Septic Tank (Specify Requirement s ----------- - ------------------------ ----- - ---------- Disposal Field (Sec Requirem tsO,..... --------------------------- ----------------- --- __ ............ --------------- . ------ 0. {Draw existi. qg rind required addition on reverse side) I hereby certify tha I have prepared this applicati n and that the work will be done in accordance with San Joaquin County Ordinances, State aws, and Rules and Regulat" ns of the San Joaquin Local Health District. Home owner or licensed agents signature certifies th±e following: i "I certify that ijth"02 erformance of the work for hick this permit is issued, l shall not employ any person in such manner as to become su ]Q[�'s Compensation ws of California." Signed.... max' . --- -----. - ------------ Owner By------------ ................ --_--- ....... Title............................. (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.- _. ...-_-- � �. ..................DATE ._�...�.2 .. .... ............... DIVISION OF LAND NUMBER. ........!... -- - --------------- ---------- -------DATE.... -----... -- -- ........ ADDITIONAL COMMENTS�' -7 ' "�r� ". --------------- ------- ------------- ................. --------------_---- - .......................... ----------------7:------ ---------- ------- ----- Final Insgecfion b --------------- ..Date......_..._ 2-3..\-- _ EH 13 2d SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 Rev. 7i76 3nn