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L FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -.._ - -- Permit No.7.7--- (Complete in Triplicate) -- Date Issued.. - This Permit Expires 1 Year From Date Issued 77 Application is hereby made to the San Joaquin Local Health Dis'tlict-for a permit toconstruct and install the work herein described. L-his application is made in compliance with County Ordi�naance No. 549 and existing RRu+les andd Regulations: / ` Tuner's Name-- _ -r - -/1� Lir ..LG lky TENSUS TRACT----tZg JOB ADDRESS/LOCATI N._ .S7�y . A=s r t T} ` J- --- - ---------------- ---- -------- - --- ------t---- Phone_463,9:Z�6_. �Pddress_l7 QQ�� - ! City----- �17-��---------------zip----- //g§:' Q Contractor's Name_.ELicense #__.-./ -_- ---Phone.__ y nstallation will serve: Residence. Apartment HouseE] Commer ii I ❑ Trailer Court ❑ Motel � ! Other-__r}'l.cxp/-/+,�".../`,�PM..�, Number of living units:_.l.---_-----Number of bedrrooms_p__I -.Garbage Grinder. N0_.Lot Size--- ------------ __.__ r_ r,JJater Supply: Public System and name --- ------------- -- :------ Liivate Character of soil to a depth of 3 feet: Sand -SiltClay[] Peat Sandy Loam ❑ Clay Loam E]- Hardpan ElAdobe ❑,-- FiI❑I Matendl :,- If yes,type---------------- r [ (Plot plan, showing size of fot,Jocationof system in relation Wweijs buildings, etc. must be pl¢ced.olt=6.e 6j:idasVde.) `--� NEW-INSTALLATIONr (No septic tank or seepage pit permitted if public sewer is availa4fe within 200 feet) x PACKAGE TREATMENT [ ] SEPTIC TANK [ j Size r;:.� L.�,� ., -Llguid Depth. v ; I Capacity---./ .'.,.Type �� Aciterial _Y) `GX.CL7C-:' No Comtarfinents„� X 1 �/ -- to nearest:-Well f Tdl s _ . .Foundation- -._Prop. Line / ------ Distance REACHING LINE [ ] No. of Lines [.__ Length of each Im .-..- , 7 Total'Length ----- /,��N /I 'D' Box---I------Type Filter Material/p__ . epth Filter Material --`Q-------------------� ------- -- r _s'[(yytPf Distance to nearest: Well ✓.-� r -....Fou'n'dation. - - -Property Line__ S [ 1 Depth- 10 1 s----�r'y' ----Number-------X----__--------- RockkFFilled es>< No� LWater Table eptth"- -------------------i--------------------------Rock Size----�-�` '-1✓�_--- L Distance to nearest: Well......f�✓r.Q--..._"_-:-_._.___Foundation_—/3.--..- Prop Line-___..__- -.--_� REPAIR/ADDITION (Prev. Sanitation Permit#---------------------------------------------------Date_..---___-.._.----------.__-_.-_....._-1 Z Septic Tank (Specify Requirements)- ----- ----- --- -- ---------- ------------------------------------------------------------------------------ -' - Disposal Field (Specify Requirements)---------- _ --- - ------- ----------------------------- ------------------------------ - - - ---------- --- -------------------------------1--------------------------------------------------------------------- ----------------------- ------------- __- -.-- -.- ----- -------- - - - - (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 Coun `Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents signature certifies the following: LI certify that in the performan of the work for which this permit is issued, I shall not employ any person in such manner as ta become ub' t to rk n' Co ensation laws of California." Signed " C rLC� - - Owner [ �Q L Uy_--------------- --------- - - -- - - - o - - -._...._.._....._ _. Title _..... ........ - (If other than owner) R DEP RTMENT USE ONLY LAPPLICATION ACCEPTED BY.......... _ - -- --------------------------------- ------- --- ----DATE.--- -- DIVISION OF LAND NUMBER.- ------ -- --- ------------------- - - - ------------ ---------------------------.DATE - -- ----- ADDITIONAL COMMENTS - -- ----- - - ---- ----- ----- -- ------------------------------------------------------------------ -- --- - ------- ----- L- ----`----------------------_ ---------------------- ------ ----------------------------- ----------------- --- - ----------- ----- .....------- --- " ---------- - - ------------ ------- - ------------------------------------------ ------------------ ----- -- - -------------- ----- ----------------------- --- -- "------- ---- ----- - -------- -------------- -- --- - -- ----- ---------- -------- ------------- -- ------ LFinal Inspection by;-------_- ------------- - ` `---------------------------------------------Date_-�- -» - ---- - -- - -- - ---- -- -- - EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV.7176 3M