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FOR OFFICE USE: I ��' FOR OFFICE USE APPLICATION FOR SANITATION PERMIT � ` �� t ' :;IComplete_in Triplicate] Permit No/Q._�:d" . ''7 i -- - - ,.. i I�. This Permit Expires l Y Date Issued_ _.-�!J=-.7 •-•------------- -------------------------------i----- ear From-Date Issued Application is hereby made toi�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 Regulations7 1 gir ' , JCB ADDRESS/LOCATION N__---- __ --- -- ----1., `---- ------- ----------CENSUS .TRACT------•------ ------------- Owner's Name = {. [ - - s hone -- ----------------- f ----- Address !l = ----- --- -- ------ i -'City. � �" Z P=l - ryns i Y & 1 -. ---------------------- i ' [ 5 -- of ".(aC j nstallationsw II serve: Residence ❑ {Apartment ................ ---.------��-- --License #_.___7l__-.�_��Phone_-'� _ __.__. House ❑ C MMercial ❑ Trailer Court- Other_:__: ___ _ _ ---------- ------ Number of living units:__ '_,.___Number of bedr'o i ! goms�,_ :___Garbage Grinder---=`--�----=Lot Size Water Supply: Public System on.d name - --::-:- - ----- -- : ----------------- ------- __Private Character of soil to a depth of 8 feet: Sand ❑ Silt❑ 'Clay ❑ ; Peat❑ Sandy Loam ❑ Clay Loam E]' . HardanAdobe Fill Materiawl--.--s____.If`yes, tYP ------------------------------ (Plot plan, showing size_ of lot,:,location of system in relation to wells, buiildings,,tetc. must be placed on reverse side.) r NEW INSTALLATION:' (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) " it � • PACKAGE TRrE-ATM-ENT- SEPTIC TAN = - '_ Size- ' I------------ _._______ ___Lquid-Depfh�° __-------- °� 1 . - Ca accty �TYp - --Material----- -- :-No. Compartments `- ----- 1M' - .�/a � [H.-, � °Distanc a to nearest:.Well-' _�l,� ..._.__ -------_ --Foundation _................Prop. Line.: _.__-___ LEACHING LINE* Na. of Lines_: ____..,_•-.- . ._„Length of each line, ------ (Total __ , Length. a Gf -- ' I D' Box------------Type Filter Material:S4Pa Depth Filter Material___-_ _-_ --- _ ' Distance to nearest: Well___671i- __ o ___Fundation _______.._____Property Line_.: f --- ------____.__. SEEPAGE PIT [ Depth ----Diameter._t --_f- ---Number------------____ Rock Filled Yesx No ( _ r h I !JVater Table Depth f1- --- --f- t Rock Size,-- -3 P - Distance to nearest: WefL__., 7 `l� -------Fo, ndatio - -.. rP op. Lme---`�----------- REPAIR/ADDITION (Prev. Sanitation Permit#--.----- -------------------------_'.-------------------Date '�__7------- ____.________-____) Septic Tank (Specify Requirements)--- ----- ---------------- ------------ ----- --------=- - -- Disposal Field [Specify Requirements);.._.__-_. -------------------------- . -- .-.-.-_ .. -- ----------------- - a ------- ' '--- ----------------------- ------ f,- w . ' (Draw existing and required addition on reverse side] ((''�� I hereby certify that I have pr p tired this.application and that the -work will be done An accordance`with San ;66quin 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 cerci that in The .il� - � 5 ? ” fy perfoemaince, 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 Compensation laws of California."_ Signed -- - Owner _.. --- BY-'' - -------- --------- ----- - --- ------ ------- - - -------------- ------ Title- f_.- (If other than ner) �. ... .._a .._ - .�.... r f a a -FOR DEPARTMENT-USE ONLY , APPLICATION ACCEPTED BY=A , - - - ---------------------------- DIVISION -- -----------=------ = ! J� g = - ------------------------ DATE _ ___�`.. DIVISION OF LAND NUMBER- --=------------ ------------------------ _ .: - = DATE :: ADDITIONAL COMMENTS : ry� � - ------------------------=------ - --- -- - ---- ----- _ ----- -� ----------- l ' -/� a -------------------- -- ----------------------------------------------- ------------------------ -------------------------------------------------------------------------------------------------------- ------------ ----------------------------------------- --------------------------------------------------- ----- Inspection-by:--- - - ------------------------------Date- ----- ---------------- -------------------- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 REV.7/76 3M