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3 -OR OFFICE USE7 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �c�- (Complete In Triplicate) Permit No..77- Date Issued �`/y 7 7 This Permit Expires 1 Year From Date Issued :ation is hereby mode to the San Joaquin Local Health District for a permit to cWstrvct and install the work herein described. pplication is mode c m lion ith unty inanc 549 a exitt' g ules a d Re lot' ns: lt ll >DDRESS/LOCATION' (• _. CENS_US TRACT........ ,�Q.9 s Name FI�.... .r7l�i .:. r i..--J...., ... Phone.. . ti City : �. -._.._...� __zip.._......____......_ 3cror's Name . _!, ' . • . ..>�/�� !. �+)r�J-%t.t,_.i license %.:w'y.S S'� Phone.'rT. lotion will serve: Residence] Apartr.ient House❑�' Commercial�] Trailer Court [3&el ❑ ,er of living units: . Number of bedrooms_.- .. .Garbage Grirttler:. t 5{so ... t:r.�f.�x��...+............. -•.. Supply: Public System and nomc cter of soil to a depth of 3 feet: Sand t--) Silt❑ Clay ❑ PeatSand Loom❑ 'Clay Loom_ C] Hardpan ❑ Adobe❑ ' Fill Material .. . ....If yes,type....:5 ,Ian, showing size-of lot, location of system In relation to wells, buildings,etc.must be placed on reverse side.) ! O INSTALLATION: (No septic tank or seepage pit permitted if public sewer is ovoiloble within 200 feet,) 4GE TREATMENT [ ] SEPTIC TANK Irl Size .r'':' `.cC.2:• .. ... liquid Depth: . t ' Capacity_'?~.)- .Type A .prwL . Material...:.. .... .::. No. Compartments ' Distance to nearest: Well/A11W..1P.........................Foundation. Ago- . . Prop. Line '.....4..: flNG LINE !1 No. of lines_.. .__k!.Ii:Length of each line�Oje,o'Totol Length /.%..J.;.ti...t% .. ...... !..' 'D' Box j .. Type Fill 'tAoteriol,.:.4.L...&'� Depth.Filter Material ................ .............. ...1._. ; Distance to nearest: Well./(.4. Foundation.. .........Property Line........... GE PIT ( ) D 0./V.'�poeter.,:..... ...... .Number. ...,�.r..........i_,.. Rock Filled Yes C3 No'❑ _ Water Table Oeptfi .....:..._.............................- -....:.t•:r.Rock e•' ... ....... . .. ..............._... •,jr I , Distance.to nearest: Well : .::.. .:..r.............r�,....._ Foualidati :-:..�._.Y: ..Prop, Line.-.__.......... l�.. t/ADDITION (Prev, Sanitation Permit# . . ....:.........................Doh. ` ) Tank (Specify Requirements)'..'. _. . ....................... ............. ... .. • ...i.a. ............. ..'........................,:........I......... , .. ial Field (Specify Requirementsi. ...- .........:.................. .,.... '...».. ..._ ................... ..................... r. _. ........... ............... ........................... . ..... ; ,. .. ...................., ...:... _+:. _ . ........... ..... ........._........ ......... ........ ................ ............. } . (Draw existing and required addition on reversi side) )y certify that 1 have prepared fhis application and that the work will be done In accordance with Son Joaquin CovMy tnces, State Laws, and Rules and Regulations of the San Joaquin Local Heolth District. Home owner or licensed agenh ure certifies the following: ify that in the performance of the work for which this permit isIssui6d, I shall.not employ any person in such manner Ias oma subject to Workman's Compensation laws of Colifomio.'' I.. .{.. . ... ' .n. ...Owner- ' .......... ............................. .........e.-r...,.,............ Title. /'.......... 4� ............. ............. ...... ......... (If other than ow r) ' FOR DEPARTMENT USE ONLY 's' — - ---- ----- :ATION ACCEPTED BY. .. �� .......DATE . . .I . 7Z_................. ... ... ... ON OF LAND NUMBER .. ' . :..._... .... ..._ . ......................-..................... .... ..._.r..:.. ...:.. DATE ..... ........�.......�..... . ..... . .. IONALCOMMENTS .......I ....... .. ................. ................................. ........_........ ...... ..... ........:.......... .................I::............ .................•......I.......................... .........."r.:.....J_......... I.......•........ ..� ................• .. .}. .. nspection bye. .... - ................ ... .....Doh:......... .................. ......... SAN JOAQUIN LOCAL HEALTH DISTRICT ras 7t6»V&V'7/ft ifs • I .