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� 5 FOR OFFICE USE: FOR OFFICE USE- 3_-3 v rCounty TION FOR SANITATION PERMIT ---------------- ------ ------------------- {CompleteinTriplicate) Permit No.77-1;��-- -1 Dcite Issued...it Expires 1 Year-Front Digte Issued Application is hereby made to the SaHealth District for a permit to construct and install the work herein described. This application is made in compiionOrdinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATI N.- -- --- --- ___....CENSUS TRACT--`------- `---------- ----- 6M.) ---- t J r - - `, E . � 2 1" ! ,2Owner's Nameor----- ----------- ------- Phone-- Adsdress " ---------------------------City. `d ..__Zip_'e? Q 7_,_ Contractor's Naive -- -- - -- =y--- ---- - �-----------=------'-----' - License #-a��,`2��-�---Phone_��•_�_`vZ-�f�#.�:�/ Installation will serve: Residence Apartme t`House.❑ Commercial ❑ Trailer Court ❑ ' I Motel ❑ Other-- ----- ---------------------------- -- Number,of living units:----'__:---Number of bedrooms-'9 ---_Garbage Grinder..__________lot_Size, _ S:Q :______,_________ �Charactertof soiPl tol'a depth of 3feetme Sand E] � Clay - ---Peat -.-- ---i__-_--___ - Private -- ----- -- ----- --- ._ = ❑ ❑ y ❑ ❑ - Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ AdobeX Fill Material-------------If yes, type-------------------------------- .(Plot plan, showing size of lot, location of system in':relation to wells, buildings,Fetc.must be placed on reverse side.) NEW INSTALLATION: -(No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ---`-_-- _------_ -_ [ ] SEPTIC TANK-[ _ Size Liquid Depth -------- ---------------- ------ Capacity Type = = Mateaial- ' No. Compartments-- Distance.to nearest: Well=,-f-------------------- ----------- Foundation-------------------_------Prop. Line._-------------------------_ LEACHING LINE [ ] No. of Lines--------_-------_',._,,_,_____.,__.Length of each_ling.----------------------------Total. Length--------:---------------- ---------- 'D' ._ ____'D' Box--,---------Type Filter:Material--------------1----Depth'Filter Material__1____._,--------.----------------------------------------- - -. f W Distance to nearest: Weill_______-_'-----------------Foundation----.-------------...........Property Line----------_------------ SEEPAGE PIT [ ] Depth------------_---Diameter_'----------------Number-------------------------------- Rock Filled Yes ❑ No ❑ r° i -AL Water -�.no �..+�.. �v L Water Table Depth-------------------------------------= ------------ Rock Size-----'-----......tom,.,-------------------------------- a Distance to nearest:WeI1_ --------------------------_Foundation---------------------- .Prop, Line----------------------_L.__. REPAIR/ADDITION (Prev. Sanitation Permit#--I--- ---- -----------------------------------------Date.....:-_____,_._____._____________-_-______._) Septic Tank (Specify Requirements)------:___-.. "- " ;= , -- ------ - -------------- --- Disposal Field [specify Requirements) s � - S- --------------------- -------- ------------- _ = - ------------- - --- ------------------------------------- ------------------ - ja r -------------------------------------------------------------------- - - --�---------- (Drow existing and required addition on reverse side) I hereby certify that I have prepared this app lication-and-that-the-work Twill-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: ' "I certify that in the peFiforrhance of the work for which this permit is issued, I shall not employ any person in such manner as to become I ct o Work an's om ensation:.laws of California." Signed------' ". ----- ------------• -- . .. -:----- -- --- ---Owrier By-:----------------- - -` ---------- - ------- " -------------- -------- ----------' ---------------- (if -----------' .(If other than Tier) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-'---" ---------------------------------------------------=-----------------DATE.--- ;7-7--------------- j DIVISIONOF LAND NUMBER-- ----------1.00--------------- - --------------------------------------------...----------'------------ DATE..-----------------=--------------------------- - ADDITIONAL COMMENTS-----------`--------- ------------------------ - ---------_- '------------------- ----------- ------=--------- ------------ -----=----------------- ------ ------------- '--------------------- --------- ------ ------------------- --- - - --- --- ------ - T - --- � ^-- - -�------- Final Inspection Da- ------ EH 13 24SAN JOAQUIN LOCAL HEALTH DISTRICT F21677 REV. 7/7h 3M