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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------------- -----------=--- Permit No.72-.n/ (Complete in Triplicate) ------------------------------------------------------ -- Date Issued---7�7.__ -<1,7 --------------- -------------------------------- 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 co3,p)ia ith County Ordinance No. 549 and existing Rules and Regulations: //' rt e, -------CENSUS TRACT---- --- ---- -- --------------- JOB ADDRE55/LOCATION_.-,. _- -�T �-- ------------- -- - Owner's'Name------- ---- / _ _: � 2Z. .SP /; Address. ----- ------------------ 1e_.-/-15------Q--�- �--I--�--- -L-�d F_CitY- -- ,., Phone Zip -- ---------------Phone .---- -------- License � � -Contractor's Name---- -'t Installation --- will serve: Residence Apartment E] I Commercial ❑ -Trailer Court ❑ �a��! of F Other-------------}---------: ---- -- ---------- Number of living units:____ �J___f._ ____._:____Garbage' _ � Water'Supply Public System and name _____ _ _ __,_ h� ----._ Private ❑ - ----------- Character of soil to a depth of 3 feet: Sand ❑ Silt�, Clay ❑ Peat ❑ andy Loom ❑ Clay Loam Hardpan ❑ lAdobeK Fill Material-------- __If yes,type (Plot plan, showing size of lot, location of system in relation.1to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: (No septic tahk=or-seepage• pit-permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] . SEPTIC TANK --------------------------------------Liquid Depth-- __ ___.__ Capacity� � pe._ ______ .Material�_� ---No. Compartments_______...--- � : l i -, ` e Distance to neares.t4.Wel L____1'�x-Za-___= Foundation_.__©__ ---------Prop. Line______0-__.___________00 - �� dT,t LEACHING LINE No. of Lines-------- Length of,each line... __ Total Length _____.�__-__- 9 ... - - _ 'D'.Box,4_— --T a Filter 7Vlatena --- =�`- r --- Filter Materia -----------,-_----------------------------- I? ----.-- -- ------------------ oDistance to nearest: Well_ z_fundation------------------------- _ Prop ertY"Line _,_ia --- SEEPAGE PIT Depth._ ....Diamete r._ 1__----Number---------- ------------------- Rock Filled Ye No E] t Water Table Depth----�Gr7_f'f------------------------- . IA ei --� .— Rock Size �- tr; mpg � r Distance to nearest: Well._. — -------------Foundation.__-/_fLY---------- Prop. Line___.___ifj_�_____.____'__- REPAIR/ADDITION (Prev. Sanitation Permit#---------------- --------------------to------------Date------'.---------------------------------------1 �•. - . .1 . S _ - Septic Tank (Specify Requirements)--------:...._.___.___._: _ __'_ -` ------------------------=------i-------------------------------- ------------------------------------------- -------- ----------- ------- 3. ..a, Disposal Field (Specify Requirements)------- -- --------- - ---- — ----------------- ----------------------- --' --- _ ------------------- ' ---- -------------------------------------------------'----------------------------------------------------------'----------'--'---------- -- (Draw existing and required addition on reverse side) 'y 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: "I certify that in the ps rmance of the work for which this permit is issued, I shall not employ any person in such manner as to..become subject tv rkman's Comp tion, laws California." i Rf . 5lgned -------._.��-� .. --------- ------ By - - Title. Cti = R -------------------- r (If other tha r • R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.---I l- - -- ---------------------------------------- --------------------------------DATE -- -,�-' ---------------- DIVISION OF LAND NUMBER -----------------DATE------ ------------ --------------------------- ADDITIONAL COMMENTS--------------- -------------- -- ------ ------ - ------------- ----r------------------ ----------------------------- -------- - ----------------------- ----------------- /� 7 �'i-- �f�- , C ---------------------------------------------- ---- -. ------------------ ----------------- --- - -- 77 - ------------ -- - - �. Final Inspection by.:-- ------- = Date - � �-7 EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT >:as 21677 REV. 7176 3m