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I FOR OFFICE USE: FOR OFFICE USE: r APPLICATION FOR SANITATION PERMIT ig (Complete in Triplicate) Permit No.�.7`_s._-._.- ------ ----------- Date Issued...6-....-_;-._7_. 7 V.----------___-___...___.._..______..-_-- This Permit Expires 1 Year From Date Issued %pplication is hereby made to the San Joaquin Local Health District for a permit to-construct and install the work herein described. 'his application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: !OB ADDRESS/LO��CATIQ]N.. S_ Tyr ---G- tTfO__l/cf�.-/`Ca--.-_J�,�ENSUS TRACT.....95l]g._._...___... Dwner's Name_? ).e� - �USJ_ ---- ----------------- - - ----Phone_e63t -:Z-3-36 ---- ------- �� ] Address__jZ_ �` ..._ --- � � h --- -----`-------..._ City....��ACCK)-------------Zi +^ P p�/} Qn Contractor's Name_.:_�C.l�.-..__:O LN5�- ..; Q��J6f.>.'t,S__ -License #-__-/ys---_---- ---Phone_--o�.7_:z1.Y�- wjnstallation will serve: Residenceto Apartment House❑ CommerF ip 1 ❑ Trailer Court ❑ j Motel, Ot``her--_A101g/-�----,tJoM_E. Number of living units:---1._.-_----Number of bedrooms-----1------Garbage Grinder_NQ_Lot Size_-____--___-____-.------------------------_----- "Water Supply: Public System and name----------------------------------------------------------------------------- -------Private X Character of soil to a depth of 3 feet: Sand W' Silt❑ Clay❑ Peat❑ Sandy Loam ❑ 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 pl ced.on reverse tide.) NEW, INSTALLATION: (No septic tank or seepage pit permitted if public sewer is availableiwithin 200 feet,) -PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size ---Liquid Depth ,,,ti �o -r-- m I Capacity-_'(20. -_ -Type At G fZJ Material 4° "-No Com sarPments Distance to nearest:Well �� .- -_ -.-Foundation - _ __.Prop. Line .. .j —LEACHING LINE [ ] No. of Lines. - - iLengTh ofHach li ----- -7 Total -Lenges .__-. -_ 5�-- 'D' Box _I------Type Filter Material/k.. npth Filter Material ----_ _ Distance to nearest: Well-_- - .-�� 1 '} � ------------------Foundation---- --- -----------Property Line..-167.0--------------'� / � r SEEP 7fF' [ ] Depth-A0*' - Qiameterf x-g -.Number__.._Z-__ --- ---------- Rock Filled Yes No L J�itsi!'ra� Water Table a th---------------------------y----------------------------Rock Size--- Distance to nearest: Well-.. ------------------------Foundation_1 ______-_Prop. Line..... REPAIR/ADDITION (Prev. Sanitation Permit#--------------------------------------------. -.Date-._- -_ -_ -_---_--.--.-- --_-----__----) L -------------------------------- __ __ _ _ _ Septic Tank (Specify Requirements)---------------- ------------------------------------------------ -------------- -------------------------------- - - -� Disposal Field (Specify Requirements) ------------- L------------- ----------------------'-----------------------------`---- ------------------------'------------------------------------------ ------------------------- -- { (Draw existing and required addition on reverse side) I 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 6mOrdinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents signature certifies the following: 1 certify that in the performan of the work for which this permit is issued, I shall not employ any person in such manner as to become ub' -t to rk an' Co e{n�saation laws of California:' Signed ----------------------- - --------Owner L By.--------- -------------------------------------- -------- Title----------- ------- - - -- - ------------- ---------- --------------- Ilf other than owner) OFRR DEP RTMENT USE ONLY L APPLICATION ACCEPTED BY-------- -.----------------------------------------------DATE -- -19 --2Z DIVISIONOF LAND NUMBER------------------------------- ----------------------- --------- --------------------------------DATE---------------- ---- ----------------- ADDITIONAL COMMENTS.--------... ------ ------------ --------------- --------------------------__ ----- --------- ---------------- L----- ------------------------------------------ ----- ----- --- ------------------------------------..------------------------ - -------- ------------------------- --------------------------- ------- ------------ ------------------------------------------ ------ - - - --------------- - L Final Inspection by: - - - - Date----,7/., �� --------'-`------------------ - ----- L EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV.7/74 9M