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a FOR OFFICE USE: ' FOR OFFICE USE: i APPLICATION FOR SANITATION PERMIT 77777 ? (Complete in Triplicate) Permit No.. .._......-•---- -_.. _---------- _ ................. 9-i� -7� Date Issued..... .............. ...... _ This Permit Expires 1 Year From Date 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 is made in compliance with County Ordinance No. 549 and e5ds' ing Rules and Regulations: f JOB ADDRESS/LOCATION------.-. 9yea---------�.. . . ,r-NwT.. A .�-� .....ACENSUS TRACT.--------•---. . .-----• --- .. Owner's Name.. .. N........11C.4v� G - - -....._._. ......... ............_._....--- .. ........�- . _Phone ..-- ------ --- ....------ < . .. /_ ,1. Address ! 9Y�a WI've. 4�� .:- r.Y/...G.. s�6zip - � .... ........... .. . ....Y� Soty ; ------Phone._S ------- Contractor's Name --- --------------License #A 1 i Installation will serve: Residence ®) Apartment House.❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other........ ) 1 \ Number of living units_______ ______ y g / NGYeS r. Number of bedrooms-....__._.._Garbo a Grir�der.y�tL.....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 �d Hardpan ❑ Adobe ❑ Fill Material_ . .. . ..If yes, type.....- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. ust be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ j SEPTIC TANK [ ] Size--- -------------...... _ I----------------- ---Liquid Depth ....__._.____-..____- obe �T 1 3 �Go ti Capacity..-------- ----•----TYPe -� -------- - f---._Material-•----- -.•..,......,----No. Compartments- A------- --- ------ - Distance to nearest: WeIL.._.._.I a-- Foundai'iov----��-�--. ---------Prop. Line . b.�............... 9O.Yr'_------c�Total Length_.�LO...... LEACHING LINE ( } No. of Lines-------- _._.....-__.. ....Length of each line. ,,,•,• ..................... 'D' Box_. _....Type Filter MateriaL4V<-1;----_Depth Filter Materia -------------- /---------------------- --. t 1 / _ Distance to nearest: Well__.__.�s _ .-----Foundation -±...:ZS---------------Property Line--10----------------- --.- .- SEEPAGE PIT [ ] p Rock Filled Yes ❑ No ' -- - Water Table Depth--------------- -- - -----Num- eY'--.........---.Rock Size-----------------------------------. .-. ---- P Distance to nearest: Well.... . ______._---. !..........Foundation---_ 1_.__.Prop, Line..-__..............______. REPAIR/ADDITION (Prev. Sanitation Permit#-----------.. ----------------- ------ ---Date..........------;--.---------------------- Septic ------------...._.._ 1 -----------------N Septic Tank (Specify Requirements) - - - / - - - ,_..- r •- ti v Disposal Field (Specify Requirements)...................... . ( -- =-- -- •----- - j ------------4.-•----•. Y' f .... ...... --------------- ;? existingand required ad ---------- --------------- ----- ------------- ----- ----- --•-• -----.....-. ................q 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: f "I certify that in the performance of the work for which this permit:is,issued, 1 shall notemploy any person in such manner as to become subject to Workman's Compensation laws of California." Signed... .. AN-------.ti - ----"r*-----.•dui ------Owner I ✓� ----------------- By_......��.C/ -- Title 4toeinr han.owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..................................DATE ...-^--- - � 7----------- DIVISIONOF LAND NUMBER..._.._....-. .._ . •-----------------• ... ---------DATE-_------_------•-•---- -__------------ - ADDITIONALCOMMENTS--------------- ---- ------•--•------ ------------•-• -•------- ------ -- _ -- ---------- -............--•---k•---------- .. -----•.. <° ------ ------- -------------------------••------------ - -------------- \�. �&� ....... A _ %,_, c1 ------ --------- ...... -.................................. Final Inspection by:.......... ` ........ .....Date.-- � •= EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fd.S 21677 REV.7/76 3M