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) FOR OFFICE USE: FOR OFFICE USE: APPLICATION`;FOR SANITATION PERMIT --------- ------- ----------1---/-- (Complete in Triplicate) Permit No.- :�� --------------------------------------------------------- l Date ------------------------------------------------ ----- -- This Permit Expires 1 Year From Date Issued Application'"is lierehy,mode to the San--Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in complia ice`with County Ordinance No. 549 and existing.,Ru_les and Regulations: 4 JOB ADDRESS/LOCArON ' �. = - r------ ENSUS TRACT.-------=------- _ ` - } -'•t-_------------ Phone-"--------------`-- t -_ Owner's ame , .`a' - �. - ': - �, �-£s f . _ -- ZY . Address_ r ------- Ist t g I r _1GI '4 a a_.=-1 City T ✓ H 1ZrP _ Contras or's Nam ' _. r.ir : _ r�.--'F�._r ✓ -t. .__License r. ,s ' �' ------Phone eP "e _ Installation will serve: Residence ❑ Apartment House Q' Commercial ❑ Trail £;4& ffl ! ` Motel-g—Other_-» -- _------ - ---- a : Number of living units: ------Number of bedrooms ~ Garbage Grinder"* =_.Lot,Size' /,�„`ry;� ___' ''' '".- __- r Wpter Supply: Public System and name__.__ __'_' - :_` '�- _.__'_* . I :- - - - � 'Y-�--------------. .__�----�------- ----------------------------- - Private Character of soil to a depth of feet Sand s❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑„_ Clay Loam ❑, =„ P ❑ _ r s Hardpan Adobe FiII MateriaT`�' 'If yes, type-------------- """ - -- f (Plot plan, showing size of lot, location of system in relation to"wells, buildings, etc, must be placed on reverse side.) . i NEW INSTALLATION: .[No septic tank"or' see page":pit"per-miitedif public sewer is available within 200 feet,) PACKAGE TREATMENT [-] SEPTIC TANK" Size ---------------t-- ___ ----- ------------------ '�'^'------ Liquid Depth . :. . CapacitY +�:`t Typed»• ..,' 1 _Material __+_•r,,4rdY P ( - '--------- fi _No. Com artments__y - bistance to nearest: WeIE _ _____-----------._.-_._.___.:____Foundation.°_________._.______...Prop. Line_�__�>.----------,-------_- r LEACHING LINE Na. of Lines_ Length of each li.ne.___, � ".. '_:___.To#al Length 'D' Box'' ___Type Filter Material _____ Depth Filter Material_. X-------------- __________ ! Distance to nearest: Well__ Yf ` f - ----- -----Property Line. . _.__ -_. --------Foundatton = ___:.__.Diameter_--^�'� Numbers -,....._..., .' Rock Filled Yes. tNo } SEEPAGE 'PIT Depth^ ��. - «� Ej _ —'- i _ Rock Size-- - >---------=--� a Water Table-Depth �-��-=------'=='-------------------------, -� Distance to nearest: We --------.`--------------------=------Foyridation-f__i- Prop. Line--`, .---------- ---------- REPAIR/ADDITION [Preva Sanitation Permit#--------______________ ------------------:Date '___.__.._.__-__.____',--_-_---__ -) .,. .�...�_. �.._._.. .. .r. t Septic Tank (Specify Requirements)------- "` ::- ----- --- -=----------------------------- - ---- ----- Disposal Field (Specify Requirements)__ °—'—' --------- ------------------------------------- - - ----------- ---;- ------------------ -- -------------- - -- ---- ---- ------- - ---------------------------------- --------------------- } ---- It (Oraw existing and required addition on reverse side)" s I hereby certify that I have prepared -ibis application and that the work will be done Kin accordance with San Joaquin County Ordinances, State Laws: and Rules land Regulations of the San Joaquin Local. Health District, Home owner or licensed 'agents signature certifies the following: T t "I certify that the perforinarice of the work for wliI-H this permit is issued,.l;shall.,not_employ any person in such manner as to become subject to Workman's Compensation laws. of California." UARENCE'S SEPTIC & SEWER SERVICE 5g re _ Or 263 So. Oroantotcrdkctoton, Calif. .]p�9256 2�Q�5l�: Ph_463.3209,_Title --------------------------- y CYd ------ r Br. 4 (if other,th owner) -z I a 'I O DEP RTMENT USE ONLY t k APPLICATION ACCEPTED BY--------------- - =----------DATE-----------N S_____,_',_,r_ ti DIVE510N OF LAND NUMBER. = --- ------------------ I---------.DATE-•----- ------- ---�------- --- _ ADDITIONAL COMMENTS.------------ f ----- f --------------------------------- ----- }-- --- - -- ' ?%Z-7170". - - W �.wwM.wwM..R�-Y' - ____. ------a------------ _ Final-Inspection bYt---- -- ---------- ------Date.-... EH T3 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV:7=/76-3M