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FOR OFFICE USE: t FOR OFFICE USE: 4'L APPLICATION FOR SANITATION PERMIT _ - ------------------ . ----��----- Permit No._.7S . � (Complete in Triplicate) - ------ - 7� Date Issued-..-3--/e'- ..__..._-_._ ----- ---------------_------------------------- This Permit Expires 1 Your From Dab Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application i's made in co pliance with County Ordinance No. 549 ad existing Rules and Regulations: fOB�lADDRESS/L!/OCA/TI� f1__._ . ®/ 733' '-� / L/�. .. .�./�R-._------ - .--_ ._T'-:`....._.CENSUS TRACT.-------------- ------------- Owner's Name.—.77 ....---------�':i irele-AQ; - Phone.------------------------------- Address_._ 5637 . -� A - - ------ - � y�,, y QSVF - r p Contractor's Name-__- - �_._!J h U_ -[_-_- -License Installation will serve: Residence ❑ Apartment House[] Commercial F Trailer Court ❑ Motel ❑ __O�ther-------------- //...-� - Number of living units:_.`'o-Number of bedroom`s.�Garbage Grinder-(9L-Lot Size--- ---------- -------- _-------------- __. Water Supply: Public System and name --------- ----------------- - ------------ -------------- --------------- ------------ ---------------..Private Character of soil to a depth of 3 feet: Sand ❑ 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 placed on reverse side.) w NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ /1200 Size..... ... ___ ---_ ------------- ----_-------------_Liquid Depth ...... Capacity. --Type.----------------------Materialt lli*+S^'�_No. Compartments----2_---------------- -_� Distance to nearest: Well...._.._ -.Q�......_____ ._..Foundation----/�-.s.---_------Pro Line. LEACHING LINE [ ] No. of Lines__ -----/-__-------__Length of each line_-•� �---_. ----Total Length A710.-_._.._....___.._.__ �r 'D' Box...�✓El.Type Filter Material-_.f?IC.&_._ Depth Filter Material-------1g.__...-_..______..................___.._. Distance tone rest: Wel I-----._l1_J'. Foundati n -- -Property Line._.__-__ ,-.___._._. - p m SEEPAGE PIT [ ] Depth..05._Diameter...0 __-__Number_...-7_- _..__.__ .... Rock Filled Yes [4 No❑ i Ze I a Water Table Depth- .------------/00L---------------------------.Rock Size...----I-Z--------Z--Z------------ p, Distance to nearest: Well...__-_&6_+............__...._Foundation-------".>.SO___...Prop. Line......Z_.---_.--___.. REPAIR/ADDITION (Prev. Sanitation Permit#----.---------------------- _.-------------------.Date----------------- _._.._.__------._-.) Septic Tank (Specify Requirements)------ ---------------------- Disposal Field (Specify Requirements)._----- L---------------a-_-_..------------------------------- ------ -----------------._------.... -......-----------------------------------------------------------'----------------'_-------......--_------------------ _..----------- ..------------------ (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 County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents signature certifies the following: I "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 to become��sttu��bje o Workman �'�C-ompp�en�sa�tioonp laws of California." Signed-_--f1"- --v.tr-Vt."�''�"'-`�-F"-L _..----......Owner By-_-------------- - ..Title (If other than owner) DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- --- - - - -'-- --------.:..... --- ----`-----------------DATE•' -3 f DIVISION OF LAND NUMBER. - ---- --- ----- D E. ------------------------------ ADDITIONAL COMMENTS.._-------- sit--v,YJz:v�--------�-.' ------ --._9`f1�-- - ----� � -Z':' -f�------------------_.....__-.. -----------------_-----------------------....------- - ---11I Flnal Inspection by: rs - -- ...... - Date - --- e, 1324 SAN JOAQUIN LOCAL HEALTH DISTRICT F6521677 REV.7/763M