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FOR OFFICE USE: FOR OFFI or APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permi o...7. .-.:`a..... ---------- ---------•----...... - ............. ........ this Permit Expires 1 Year From mate s ate Application is hereby made to the San Joaquin Local Health District for a permit o and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION. i. -. s ' , ✓ " ''"%............... s7.� , , � - `r -T, -�"i 4th;G SLIS TRACT..-------•--------•------ Owner's Name_..... t�._L "' f.. � ...•. 'f '------- -_ • -- --- - ----------------------- ---------- Phone Address... �-�:..1. .... '' f' � �r�— r•,• • ..., i a ... .. City... dip Contractor's Name e: f `?f 1 J -- t. , - = .. ......License #__. Phone f d r 9 J Installation will serve: Residence [ ' Apartment House ❑ Commercial ❑ Trailer Court ❑ l Motel ❑ Other------ --------- ----------- --------------- Number ---- --------- Number of Living units:.__../.........Number of bedrooms.....7...Garbage Grinder---.-------:Lot Size....--�--_. �-.�._. --.-.�- _.._. .. .... ---. .�.. ,�_' <e " � . --------------------------- ---- Private ❑ Water Supply: Public System and name.- ti= : Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loom ❑ Clay Loam ❑ Hardpan ❑ 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,] W 1-1 PACKAGE TREATMENT [ ] SEPTIC TANK [ ) Size- .. ................... .. ........Liquid Depth_/A... .- --- ----•- Capacity../. 2 .. Type " .. Material.a lam:-T No. Compartments...... ! %------------------ Distance to nearest: Well -----� f '1 --- ----------------- --Foundation...... f!'.. ..........Prop, Line---.-....--...........-.--.. LEACHING LINE [ ] No, of Lines ...............Length of each line ...._ - h_ ..Total Length..L/. r,�---.-.-----.. 1 'D' Box,d-e-�ArType Filter Material.-_.-�_-mo Depth Filter Material.. .;,..... ._......................... l 1 Distance.to nearest: Well........................... � dation...._.._-.-._..___. . oun ........Property Line_.--------_------------------- SEEPAGE PETs.. �� [ ] Depth...�A .9....Diameter... 7.......Number.-.... -.-1.--_--------------- Rock Filled Yui'`[] Na WaterTable Depth--------------------------------------------- -------- --Rack Size.--- .- �-- _'.... ..-...........---------- Distance to nearest: Well................ ........ ............ Foundation_......_...............Prop. Line.----------._....---------. REPAIR/ADDITION (Prev. Sanitation Permit #............................... ---- Date.........----------.-----_----_-----.------) Septic Tank (Specify Requirements)./.... •--- Disposal Field (Specify Requirements)_ . ........-------- -- .-------------- - (Draw existing and required addition on reverse side) 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 J signature certifies the following. {) "I certify that in th I performance of the work for which this permit is issued, I shall not employ any person in such manner as to became subject to Workman's Compensation laws of California." �1. Signed s - ... -------Owner elzo By....----•----•-f---- ...- - -•--�... -........ ...........Title_ - ...................... --- ............. • -- ......... (If other than owner) I/ FOR DEP TMENT USE ONLY APPLICATION ACCEPTED BY......... ..........--•---- -------------------- DATE......... .................... DIVISION OF LAND NUMBER--------- ---- -- -- --------- - -.-.DATE.--- ------ ------------- ADDITIONAL COMMENTS. ................ . --- ------------- -I................. ...... ...... ............................ ... ----------------------- ------------------------ ........... I------------------------------ -- Final Inspection by: . ---pate Ek 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fay 21677 REV. 7176 3M