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FOR OFFICE USE: r FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No._-.-----_.-__---- --------------------- --------------------- This Permit Expires 'I Year From Date`1'ssuecl �' Date Issued.L _-1I--- Application 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 co pliance ith Cou ty Ordinance N . 549 and existing Rules and Regulations: Y�� ,� JOB ADDRESS/LOCATION. ____S�Dc - 5Ye`� �� L x?F..-f�E l �- 46� � - 6y----CENSUS TRACT_r . Owner's Name.. hl__ I (_ _ ..- --- - Pho a-- --- Address-- wZ- - - -- T c ------ - ---------------I-------- - ------------City- =.1',--r�La r� Zi 5 3Z� --- ------ -- p� Contractor's Namec>AKPIAL.c:...-C©�]Gt -Ar 4 ------------License #'�'_ ` �.,':_ -Phone- '?_` 1r74._4 ----------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other----- -- ----- ----------- ------------- Number of living units:-----_t--------Number of bedrooms--Z ---__Garbage Grinder_�40,__Lot Size__A,C�-E d Water Supply: Public System and name.---- -----------.;_-_-- _ -._ _------------ -.- --------------------------- ---- ---- -- ---------- ----------- ----------- - -------Private Character of soil to a depth of 3 feet: Sand E] Silt❑ Clay fg Peat❑ Sandy Loam❑ Clay Loam ❑ Hardpan X Adobe ❑ � Fill Material-..-_ --- -if Yes, type ----------------- ------ -- (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,) e---� PACKAGE TREATMENT SEPTIC TANK ." ( 1 � Size--- - ------ --- ------------------------ ----------- Liquid Depth------------------ Capacity ------- -- ------ - � Capacity.----------}-------Type-----------------------Material-- -----------------------No. Compartments------------------ d r'l ----------------- MN Distance to nearst: Well--- --------- --------- -- - --•, Prop. Line - - - - ., I g -----------------`-------- LEACHING LINE ➢Q No. of Lines.--_.-. _- �4'-_______-:- Fo4r3, ion__ P___________ _ _ __ C � . Length of each line.---z. -T?�=-- .Total Length -----__� 'D' Box-.O-----Type Filter Material-OVZ.-I ve - ._ ___-- -_ ,l k. Depth Filter Material--_f__ __-- Distance.to nearest: Well---_---- -----__.Foundation=_'.._�4Z__- Qd ' -------------- --Property Line---Z---- -------- SEEPAGE PIT K Depth-.:�4r-------Diameter__B-4,'--- -- Number----------- -- I _ ' ---------- --'=-,. Rock Filled Yes X Water Table Depth.'-\-------=----------- i'-L-: -- -'Rock Size- AZ C7r Distance to nearest: Well----J ----- _- :Foundation----- � Prop. Line---lleC-_�-- REPAIR/ADDITION (Prev. Sanitation Permit#- -27 Septic Tank (Specify Requirements)-------------------------- Disposal --------------- -Disposal Field (Specify Requirements)-- As7D ......... ------------------U-4 .A1-rP.A---------------------------------------------- ---------------------------. ------------------------------------------- ---------------- ----- ---------------------------- -------------------------------------------------------------------- --- -- ( raw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin Count, Ordinances, State Laws, and Rules and Regulations of the San Joaquin .Local Health. District. Home owner or licensed agent signature certifies the following: 4 1 . - • - - "I certify that"' the performance of the work for which this permit is issued, I shall not employ any person in such manner as t to becom lett Work sZCoensatloa laws of California." Signe g Owner ------- --------C-fJ__-"..- Tifile_-.l�l�-J[�AZ�_�-.--- --��A7� (If other than owner) FOR DEP RTMENT USE ONLY APPLICATION ACCEPTED BY---------------- `-' DATE. — ��" ---------- ----- -------------------- -- DIVISION OF LAND NUMBER------------------------_--------------------------------- --- - ------------------ -------------------DATE.- - -------- ---- .. ADDITIONAL COMMENTS..-LS /C.-- t-� 7 -'7 ---------------/_. ---------------------------- ------- --- 7-_-__-__-�------------------------------- - ------------- Final Inspection by:--.----- - --------- ------Date SAN JO. ,UIN LOCAL HEALTH DISTRICT Fes 21677 REV. 776 3M