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FOR OFFICE USE: FOR-_OFFICE'USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No...--1 --- ............................................. . Date Issued..". .... . This Permit Expires I.Year From Date Issued l'`f 3 --2.7 0-325 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 existing Rules and Regulations: it f.SS ,�- - �,�.-�'_r_ Di A-VF-. I i3Lit. lu a a1r H 0 F :; ' . ( )g oT :.----------- '---CENSUS TRACT............... --i08 ADDRESS/LOCATION:............. ............. ...... .......... ) Owner's Name._.. .1.i`k.Liii.t4.P.... ..._tNr_4C_ST-*A:�.tu:T'.....:--- ._. ts., ------ ....... ------Phone------- =-------- -------- q Address......PAP., fie: .. :' .............. ......... ........... . ------...:... .....city--------5--rx—pq ---- -- - ......Zip...t'#5 . D A --------- Contractor's Name....U.4.1_i.1a.--.-.--- oz-1-1.R.N.-1_t-Art., ... : . ............License Phone..19'.3- ----- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other...W..►4 PLC-1->-- _u.S'AE.... Number of living units:.... 9 e.` .i Q �.._K_...5._3, -�:>._..---- -- Number of bedrooms.... .... .Garbo e Grinder. ..Lot Size'. Chatracter of soil System of.3�feet: Sand C.ASL �-'.Q!A'�'E.tZa� ------Sand Loam-;_.... ....-----..--- -•-- ..........Private ❑� Supply: P ❑ ❑ Y ❑ 0 Y ❑ Clay Loam ❑ {�i Hardpan E] Adobe.( Fill Material _ ._.. . ..lf yes, type----......................... . )Plot plan,L showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reve 'e side.) ' NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) l PACKAGE TREATMENT [ ) SEPTIC TANK Size,_,s �X. .,5. - li!..g-------------- ,-,---,._..Li.quid Dep#h. _ ---------------- Capacity_�_ Q _(,,44-Type._ . . ....`. -.. .: - p � .Material... .t1?4EJI' 14PNo. Compartments --- ---------• Distance to nearest: Well.--_---._/4lc. ?.E..:-_-.----- --.Foundation-----, /.Q Prop. Line_._... :.-. LEACHING LINE No.-of Linesj ......... Length of each line ...._.. - ..........:Total Length ... ....------6-G> Box..No..-.Type Filter Material..-AY....-:_. -._� Depth Filter Material.:'---- ............ ......... Distance to nearest: Well-----IVOAAC.--....Foundation.-------/_�1----------.._Property Line' �-�..................�{ . t , SEEPAGE PIT )< Depth...,2�`r.�..Diameter......-3- -Number..........:..../---------------- Rock Filled Yes No ❑ } Water Table Depth---------A04? -------- ------- ------.Rock Size._.........7;Z_. . i Distance to nearest: Well-------CYQ!V- --.................Foundation........1�q7--- ......Prop. Line--.....$-. ---------•-'� REPAIR/ADDITION (Prev.. Sanitation Permit#..._.___-------- ...... Date.. ) Septic Tank (Specify Requirements)---- - --------------- .......... Disposal Field (Specify Requirements)--------------------- ---- ................. --------------------------------------------------- -- ............ ----- . _. --- ----------------- (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 cert fies the following: "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 subject to Workman's C mpensation laws of California." ,/ • �� . -----.--Owner Signed. $Y Title.-- - ------ (!f other than owner) IF7OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ........ .....':...,.DATE .. .. .. ... .......... ..--..... IJIV ION F LAND ADDIST ONOAL COMMENT BER..... .... I .....- 3f F 5..! - -- DATE.... . --.. . .... ..... . ... ..... - ------------------------ --- - -------- -- ----------•----------------------- --- ._.--------------------- ------ --- --- --------•- -----;---- -- ----...... _. Final Inspection by: ---------------- --- Date. : EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fos 21677 Rev. 7/76 inn