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II FOR'OFFICE USE: APPLICATION FOR SANITATION PERMIT FOR OFFICE USE. ........•.-__-......_--------- (Complete in Triplicate) Permit No._ 77 ._ This Permit Expires 1 Year From Date issued Date Issued.3-3/_ Application is hereby made to the Son Joaquin Local Health District for o permit to construct and install the war This application is made in compliance with County Ordinance No.349 and existing Rules and Regulations: . - --_ k herein described. SS LOC T JOB ADDRE / ATION. _'fLj7p.sr `` - _ ` Owner' . ........... ' s Name...... .._.._ ..._.CENSUS :TRACT _._ Address---- --- �� ' -= .---------• n t.sct / Phone. Contractor's Name_.:-._ - , - G � Q� city zip._ - �..:7_... „. --------•-----•---- "" . ...�..'_• . License #...�. ;.Z. ._Phone_._...._.. Installation will serve: "' Residence ` • r .- ' t , dApi�rtment,I�,ouselU_A_Cortimercial ?Traiier Court*❑ _. ► ate!•._ .� r ❑ . Other,-•:>.-__:_-...:_.-__.:.----:::_�:._:`-• ,--•-�.. Number of living units.-....... o.f,b- edroo°ms__-, Garbage.Grinder.._ , _...:_Lott-Size_ _ f.laAWater SuPPtY Public Systemnd nam ._.. i Character of soil,to a depth of 3 feet: ASnd ❑ Silt Cla Pnvat e i� ❑ y❑ Pift❑ Hardpan ❑ dobe'[] yes,type Loom C L Sandy L m la oam pe--- . Y O (P1ot plan, showing '' --- �--.—. } ' G 'size of lot, location of system in relation to wells, buildings,•etc.must be ploced on reverse side.) a NEW`iNSTALLATJON; `{No"septic' tank'�or seepage pitJpermitied if publk sewer is available within 200 fe PACKAGE TREATMEN7r,-[o SEPTIC TANK `'�,( ' �t J 12 Capacity.-Ic{.Q:D.__)TYPE• y i-1 ......Liquid Depth._*_ --- ...... Material - i No. Compartments._...` Distance to nearest: Weft.__ 30 = _ LEACHING LiNE ----'.�T.:,--------,;_ Foundation-. , -....__Prop. Line- I'_�__ [� No. of Lines.___;-.- --,3_ - •_- •• •Length of each--line.__ -. Q .y j. Total Length. ae� x- j 'D' $ox•='.-. •' •__Type Fitter Material:__ +� �'-Depth Filter Material._.`__.._-t l_'�__ k'._ Distance to nearest: Well___.. f f2Q•�. :Foundation_....__. _f2- - S- -------- btr:PAGE PIT p :• .� [ . _Property Line--•--•-•-,- [ j Depth.__.;--.-- ;- Diameter.'._._.--••---•:•---Number-_-,- ----- ........... Water Table Depth -.:..............•...... Rock Filled ?Ye ❑ ;ENO❑ l ......' .Rock Size_.._. ,tiaY � Distance:to nearest: Well.. " " __---:•---- t .. ..Foundation'"'. Prop. Line_ ._. REPAIRJADDJTION (Prev. Sanitation Permit#_____ _____________•:--_ ,,,.,�.. = Date.__. Septic Tank (Specify Requirements).:.__._.._.� ---•-,; Disposal Field (SpecifyRequirements):.,-.... - _............................- s . .. - ..qtr ..•-----••--- _.._ _. Imo. ,- -• ----- - ---•- •-k-- i ---._.: ....................... (Draw existing and required addition on reverse side) - I hereby certify that i have prepared this application and that the' will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of signature -the San Joaquin ll Health District, Home owner or licensed agents certifies the following; - oca _ I "I certify theft in the performance-of the+work`far which this permit i to $ issued J shall not employ an become subject to Workman's. Compensation-laws of .California." p y Y Person in ouch rrianner ds Signed...... ......... ' t 7• _---Crw BY f,�� net j y Title._ t' ... j (if'other than owner) • t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED.-BY:-.' ; } ' j_._QAT�__ _ DIVISION OF LAND NUMBER.--_-_:_-"---• ! ....--._---•-------------• __-- -- -•- -- ;7�=. P. ADDITfONAL COMMENTS. = = _------•.DATE.- ••-••--•---•=•-•-- ---_--._---- ___________________________ _________________________________ -._..___-_._..__.._.. ._ ____________________________ _...._• .,._.___._. =inert-inspection b •-----•..__.-- ••--_ Date _ +1 13 24 _ _.+-�-.� SAN J AQUIN LOCAL HEALTH DISTRICT F8s 21677 esv ,orb 3M