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FOR OFFICE USE: FOR OFFICE USE: . <br /> '1 APPLICATION FOR SANITATISN PERMIT 6 (� <br /> ......•..............m..............., <br /> (Complete in Triplicate) Permit No..7�.1...-..-.---. <br /> -----...................... ................... <br /> Date Issued._/O__y -77 <br /> f ------------------------- (th_i"ss1emi�it�Expires 11 Year From Date Issued <br /> Application is hereby made to Di t3{tc}for a p is+ . construct a w rk herein described. <br /> This application is made in compliance with County Ordinance No.549 and exis ing Rules and lotions: 4 <br /> — <br /> . .. . .A,r .. ... ._ 9 I <br /> ' - � CENSUS TRACT.....\. <br /> Owner'sName...�� „] . --:-/:'...-:---`::: - ----.._:..........................Phone-.�../-,�-3.�z-'---- � <br /> JOB ADDRESS/LOCATI 00.9-. �..-.;;, �J. �.. • <br /> 1 v < <br /> Address..--------S/1L --- - -, - -- ... `- - City ,;... .. . -- .. .. - ..--Zip._.. ..:. :. ....... <br /> Contractor's Name:...-�{'�N :......:.. .... ........t---- ?.............,.-.... ----.License #----,.. '..... one........... :-.....: - <br /> Instailation,will serve: i Residence ❑r Aia,igenf House.❑ Com rcial ❑ Trailer Court ❑ s <br /> :._ ot�JsrOther- /f!d _:/ `' 7 7— 3- <br /> 'tet" ' t i <br /> k Number, of.living,units:•:;_.... -.-..-Nur�r.of bedroo _- /.-.--Garbage Grinder.------- :-Lot,Size.,...--....._......... .. ............�-................... <br /> ( Water Supply: Public System andsnart a ----- ---.-„ :.:... ...... ....i... ..........----- -> ---I:, ........---..........- `-Private ❑ <br /> Character of soil to a depth of 3 feet: ? and ❑ Silt❑ . Clay ❑ ea AW101 I Clay Loam <br /> I Hardpan Q o6e ❑ steno .-...... Y tyP -- <br /> t If es, a _ � .. <br /> (Plot plan, showing size of lot, location . system in rel tion to wells, buildings,'etc. must be'placed on rev its <br /> NEW INSTALLATION: (No'-septic tank 9r ieepage"' it permitted if public sewer is available'within 2 • fe!Ij- t <br /> GE TREATMENT ( ] ; SEPTIC TANK' Size-.IDQ. `Li u` epth.:. _._..:-_........-.. <br /> . :;.. t F; <br /> t Capacity./ e---- - :M``aterial: ' .:_ ::.:::_:-::::-N r}ments -.._._.1............ <br /> PACKA to nearest:WellFoundat�n.. -------Pro . ins.....5---.'�..----. <br /> LEACHING LINE f Libe ..... f � " ength..0....._ LOG -._.. ------- <br /> L <br /> N <br /> ' teach line... <br /> r!tcx_.- .. ..Type Filter Ma Tal: / :--...Depth Filter Mat r of-r1Z........ ,.. c .. . <br /> amncetone sti 1- ._. _._. Foundation...:.-/V... -.-...Property Line.3'-.;..f-.-.-..-._r <br /> ' - - - - y ter, / <br /> SEEP j j Depth.-...I%.-.. iame AN---.. .3-.<_t7urivzlX......eR.............. Rock Filled Yes❑ No <br /> " r r Table Depth. -- .............. Rock Size. - ------------------ <br /> Waterr+J D ' Distance to nearest: Well....!.... ...........:...._.-...- .:....Foundation_:----- Line....-..-....-..-.-.-.- _ <br /> REPAIR/ADDITION (Prev:SanitationPermit#-:'__:- ..... ......_ Date.....................:..................... <br /> -...-) <br /> Septic Tank (Specify Requirements).......'---`........ ::....:. .....Z. Fi ' ........-...:.:.-:,:..-.::-...-..... - ' <br /> Disposal Field (Specify Requirements):.............: -- ............. --- -------------- ............ ----------. -----....... <br /> - - -----------=-- <br /> -- - - - <br /> ...................:.............................:...-------- -1j- .. ..................................... .-..... -.:... .. - <br /> I <br /> (Draw existi n I(eq{uir d addition on reverse side) <br /> I hereby certify that 1 have prepared this application jpd i"Ark will be done in accordance with San Joaquin Count <br /> Ordinances, State Laws, and Rules and Regulationsf•thIll Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: <br /> 1.1 certify that in the per formdncei aCthe work for which this permit is'itsued, I shall not employ any person in'such manner as <br /> to become sybLpctA `s Compensation'laws of Californi <br /> Signed.' ----.....; ._..- .-_-.._ .........:......;.__.�._......- :._;...- OWner ..._ .. ... <br /> By.�.---..,...-- ....:.............i-------....-:.......Tit e--- ....... -----.......- ------------- '. <br /> .......-.. <br /> ff' ”(If 'other than:owner) <br /> i 1 .... -FOR DEPA T USE ONLY <br /> APPLICATION ACCEPTED: BY•----------- ------------------- .. :-_-DATE._.: ... ...... - 7::-77 <br /> ----- • .. <br /> - <br /> '-DIVISION OF LAND NUMBER:.............. - --------------------------------- ................... <br /> ..-----...._.. ......:......:......:..........DATE........ ----.-----...... ,-.:........... <br /> ADDITIONALCOMMENTS---- ------- -_--..:.. -- -------------'- -- -.....,-...------- - - :...---....- :-------.......................----------......_>_..-.........- -- - <br /> .. <br /> ---- -- ............ ••--.....-----_-_.............. <br /> - --- -` �.............. ..... - ----------------- - ---- - -...... :---------- - <br /> Final Inspection by:_.. .,.. ---- ------------ --'---------- ... ---'-._-'__,. "...-...:Da .. -... ... . ..�--- ------. . <br /> --------------- <br /> rr 13 24 SAN JO LIN LOCAL HEALTH DISTRICT Fss 21677 REV, 7/76 8M <br /> t <br />