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FOR OFFICE USE: f FOR OFFICE USE: ;APPLICATION FOR SANITATION TATION PFiT d� (Complete in Triplicate) Permit No._.7 '------- ------------ ---------------•---------------- ------ --------------------------------------- Date Issued.... 7P ----- --- ---- ------••------------- 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. is application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: f JOB ADDRESS/L ATICIIV.----� -- ------------------- ----- ---------.CENSUS TRACT _ ner's Name-- --- - - - -------- . Q •------ ----- ! }. -----•------------�-•--------------- •� --•:---- -•----- ----Phone- ��- -- y address. �i`orf t. --City- -Zip- Contractor's Name---------------- .� ___--._____License #__ _]�_S_ .% Phone__ylc_5G/� - - ------------------- �Istallation will serve: Residence Apartment House C] Commercial ❑ Trailer Court ❑ Motel ❑ Otherijum ------------------ eb Suer of,living units:-----/---------Number of bedrooms`.- Ja Garbage Grinder--- -------Lot Size-----Ot Supply. Public System and name--------------------- --------------------------------- Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑, feat❑ Sandy Loam[] Clay Loam ❑ Hardpan ❑ Adobe�X Fill Material.-----------If yes, type---------------------------- -- d'lot 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,) _ ri ACKAGE TREATMENT [ ] SEPTIC TANK Size___ ------------------------Ciquid Depth.----�--------- ----- Capacity_Akd_q- Type - --Material:_-.---.----No. Compartments Distance to nearest: Well.__. _l�- ------------------------•----Foundation..�O.._____------.-.Prop. Line__7 __---____•-s---• r. / BEACHING LINE [kr Na. of•Lines___-_.d�___.._____:---._-Len.--Length of each line--,V�� g -.Total Length..-----fQ-----------------=-- 'D' Box---if---Type Filter Material. .PAC&--Depth Filter Material----/�--"---.-------------------------------------------- { ( Distance to nearest: Well__/40 ___________.Foundation.... _____ __________Property Line------ SEEPAGE fT [4" Depth--P�-. _r---Diameter-_�1e--- -----Number------_---•---------------- Rock Filled Yes SEEPAGE F �No ❑ . Water Table Depth..._11-46! Rock Size.._G7z --=------------•-------- M +, Distance to nearest: Well---- _ --- 0--------------------------Foundation---/V_40__---------.Prop. Line--- ____.___________ REOAIR/ADDITION (Prev. Sanitation Permit#----------------------------------------------------Date---------------------------------------------- ) -eptic Tank (Specify Requirements)------------•-----.--------------------------------- - DisposalField (Specify Requirements)---- ----------------- ----------•--------------------------------------------------•----------•--•-----------------•---------------------------------- --------- ------------------------------------------------------------------ ------------ --------------------------------------------------------•---------------------------••---------------•----------••-••-------------------..-•-----------------------------------....---------------- (Draw existing and required addition on reverse side) 4 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County )rdinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents signature certifies the following: r}I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as o becomeflsWect to W man Compensation laws of California. Signed !�"Ft?� =-d e /.---.--�- g ; Owner ±Y------------------- f -------------- Title--------------(:1/0 ---------------------------------------------------- (If other than owner] DEP RTMENT USE ONLY V Ile, ,kPPLICATION ACCEPTED BY----------- -- - - ----- ---------------------DATE.-- ----- DIVISION OF LAND NUMBER. ---Y_ - ---------------------- --------- •- --------------------------DATE-•------ ADDITIONA! COMMENTS .=� 5- iu iici ( g f '�f'g•-- `(--.._�zactrH ----------------------------------------------------------- _._ ___._.w_. .. :..._.. �__ ---- ----- -- -----W --•-----------• -- ----- ---- ----------------- --- ----- ------------- - --- p ----------r......•..... -------- -- -- - -- l1nal Ins ection �Y - -••--- ------- --------- Date- ------------- 1 H 13 24 _ --- AN JOAQUIN LOCAL..HEALTH-DISTRICT F&S 21677 Rev.7176 3M