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. FOR OFFICE USE: FOR OFFICE USE: APPLICATION FORE-SANITATION PERMIT - , yam'----------------- Permit No..--------------------- ------------------------- 7��--�-� /��► --.----- - (Complete in Triplicate) - -- ----------------- ------ -- Date Issued---- -_a�' 77 __. 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 existing Rules and Regulations: S b sI S'. ( ---2d - �_['f.t rs f :-----�dl_ --- -._-.- .CENSUS TRACT------- Owner's Name----------- �. _.__ �4r ------------------ = _ - Phones+----Q -- �+ + � Address —Z g.-$.. )1_ __.6—t.........R ^City-- -S -L.Q-YZ - ----- -----Zip----------- ---------------- Contractor's Name--------- -�-S:U 0 License # 3�$__a'1�1----Phone-----g-yZ-..��_ _�93 Installation will,serve: 4kesidence 2( Apartment House- Commercial ❑,;iTrailer Court E]Motel ❑ I Other.-, Number of living:`units:---. /. Number of bedrooms,:_ ___--Garbage ---.Lot Size------- .....1�}C T_C__ Water Supply: Public System and name--------------------- ' - '1 I ------..Private ------------------------- ---------------------------------------------------------------------------- Character of soil to a depth of 3 feet: Sand ❑ Silt E�'Clay ❑ `Peat ❑ Sandy Loam X Clay Loam ❑ r 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.) .� NEW INSTALLATION: f No septic tank or seepage pit permitted if public sewer is available within 200 feet,} f� PACKAGE TREATMENT [ ] SEPTIC TANK _[ ] Size----/2,o_-0...-�--.*rL----------------------Liquid Depth..�?.._________6--- _ � - ' � Capacity.1.��..a4y_._a._�.. Type_�1"_t^��..Material.�_W7crf'�'-L.____No. Compartments...... ........ r t Distance to nearest: Well...----- eIr-0 --------Foundation.._- ------..-.lProp.11Line.._- - -'T _ r LEACHING LINE [ ] No, of Lines------ ................Length of each lins.__.___ _ ___Total'Length.___ ___ - ,.7__Q_._._-_.,_..._... 'D' Box--- .-----Type Filter Material/ 2__AQrr1Depth Filter Material---------2j>� ----------------------------------------- r� S'�y� K�$X td Distance to nearest: Well.-/�Q.-'PT------Foundation.... _��__ _1 ----Property Line--,.2. at �` SEEPAGEpPIT [ ] Depth___ '�-Diameter._`#-7��.....-Number________ —................ /,�� ♦Rock Filled YesX No i _ _4 Water Table Depth---------------------------------------------------------Rock Size-------1 A!Z-.-------------------------- Distance to nearest: Well-------f aC 9_ ------------Foundation..Z7.Q...�__-___ Prop. Line- ._±-------.___._ REPAIR/ADDITION (Prev. Sanitation Permit#------------------------------------- -----------Date------------------------------------------- SepticTank (Specify Requirements)---------------------------------------------------------------------------------------------------- - ------------------------------------------------- Disposal Field (Specify Requirements)---------------------- ------------- --------------------------------------------- !-- -------------------------------- f - (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 subject rkman's Compensation laws of California." -4)+" Signed--------- - / --- t -- ----- --- --- ---- ----------Owner _/ , By----------------CIS611----------&Lai-h&e-------------------------------------Title----- ----C-0- I t_Pf(. 0 o1-501,-------6AOr (If other than owner) F EPARTMENT USE ONLY IF APPLICATION ACCEPTED BY---- ------• ------ ----------------------------------- DATE .� -- ---------- ----- --- :, DIVISION OF LAND NUMBER.----i-----------------''------------------------- = `>-----------7--------------------- -.DATE ------------------------------------- -- ADDITIONAL COMMENTS-------------------- t ------------------------------------------------------------------ ----------------------------------------------------------------•--------------------------------------------------------------------- -------------------------------- �'"� ---- -- - ---- ------- ----------- -------------------------- -------------------- - - - ----- -- - - Final Inspection b ---- -- .Dat ./ ------- p � y;-.------ � ----------------- ----------- --------------------- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/,76 3M