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_.e'"AOR OFFICE USE: - - FOR OFFICE USE: d APPLICATION FOR SANITATION PERMIT ---- - ---------------------------------------- 77— 77/ (Complete in Triplicate) Permit No__ ________-------- Date ___ ___Date Issued___R=_.,2/""-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 describb.L; - This application is made in compliance with County Ordinance No, 549 and existing Rules and Regulations: .w .. - — ...�_ - _ DDRESS/LOCATION __ ., -.,.. � - AJOB A __._ p - ---------------.--------- --- Owner's Name C4_ / -s /l r ---Phone--- r -- - ---- - --- -- Address---------------- - // l?s' Si1� _ �,. Contractor's Name___A_,, ---------- =---------------.-----'License #a'A��:��: Phone�.jz--=-/,�.��. I Instt y- Apartment House Commercial ❑ Trailer Court Installation will serve: Res�dence. Other ❑ E] Number of living units:__---------_Number'of.bedroom s_ _-_Garbe Grinder------------Lot Size---..'/- ---------- -------------.--------------_- Water Supply: Public System and name___________________________ ___ ;_;Private Character of soil to a depth of 3 feet: Sand C] Silt❑ Clay ❑ Peat❑ Sandy Loam JK Clay Loam ❑ _ t Hardpan❑ Adobe ❑ Fill Material___--- ---_-If yes, type___________ I (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) CiST (No Prrsee a e Pit Permltted iPublic eweiav 'Iabithin 200 feet,) s !fPACAGE TREATMENT SEPT1CTANKSize--- -- -----=------=----Liquid Depth.--- --------- ------------ - -t r , Capacity-1115 C t7------`TYPe_ 4- Material-----------------`--------No. Compartments-------v tDistance to nee est: Well._._.:-L ---------------------------Foundation-. lam--------------`--Prop. Line__c0-- ---------- y� ! t LEACHING LINE [y] No. of Lines:- - gth`f each lins.__..ff_-------------------Tota l Le ngth._._rr a---.------------------------ D' Box__./----_._Type Filter Materials ?AADepth Filter Material ---------------------_ __ __ __________ I Distance to nearest;Well- ------------Foundation---62_f______________Property Line-.' ----- . __.___ SEEPAGE PIT [ `] pp _____ Di.cmeter---------r'---------Number------------------------------ 1 _ Rock Filled ,Yes ❑ No Water" Table DdPth--------- -------=------' ---Rock Size--------------'' ----------------------- Distance-;to nearest: Well________---------------------------- ------Foundation --- ---------- ..Prop. Line_ ____--------------- REPAIR/ADDITION __ ______REFAIR/ADDITION (Prev.--Sanitation Perrnit#--=------------ ----------- -------Date----------------- - - ---- - ---------- Septic Tank (Specify Requirements) = -------------- - w -cam �` Disposal Field (Specify Requirements)_- ----------------- --------------------------------------- ------;-------------------------------- t--- ----- --------------------- ----------------------------------- --------=-------- --- - - -------------- = --------- -- _________ _____ _ ________ ___ ___ _____ _____ _ t ' - ��(.Draw existing and required addition on reverse side) 'tf hereby certifyThat i have ppapored 't - + -eppliEation-and that.the ,wfi& will be done in accordance with San Joaquin County Ordinances, 5tdte Laws, and Rules and Re'gula.tions of the San Joaquin Local Health District_ Home owner or licensed agents signature certifies the followin " ' . a gi I Aga "I certify that in the perfai mance of�the wor�C"TorTwfiich-this permit is issue'dy,I'shal naf{employ a y person in such manner as to become subject to Morkmnpn s Compensation laws of California."- Signed / rF Cal iforn Signed------ - - n . I p.. y _ Title-----=--------- -BY (If s other-,flian"own"er) 1:01t;DEPARTMENT USE ONLY.'.' , APPS IC-ATi 0N�rC-C-Ef�7ED-B�f -D ATE. ! - ------ -E ; DIVISION OF LAND NUMBER - ---------- =`---- t ,_-------------------DATE.------ -------------- ADDITIONAL COMMENTS-------------- j --------------------------- ------.------,------- �• �. ----------- ._ .�.� --- -- -- ----------------------------- - -- ----------- -- - -- --------- -- z .. ------ ------- ---------------- - - -- ------ ------------------ - -- Final Inspection by: :-=" __ +�,yj,; ' , _. - - Date. t ��- EH,13.24:" " "SqN jOA[�UIN LOCAL HEALTH DISTRICT r_f�j�. Fes 21677 REV. 776 sM `