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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT r r _ Permit No, - -- - -------- ------"--� ---��--�-� �-"" - (Complete in Triplicate) ------------------------- --- I Date Issued.4-2- ------,1 - -%This Permit Expires 1 Year F.rom'Dbte Issued --------------------------------- Application is hereby made to the San Joaquin Local Health District for a permit to const'ruyt-and,installl.the work herein described. This application is made in compliance with County Ordinance No. 549 and existin Rules acid Regulations: a o CENSUS TRACT JOB ADDRESS/LOCATION °:.,_.L__. -'. _y x ? / ' I =� -------------- Name ------------kv--yo------------ ------- ---------. X53 -- f1a ----- ------- City_ Zip Address----- ------ - ----- ----------- ------- - - � 1 S� L License # --- -- -----Phone-_91 Contractor's Name.--- C�1,-S_ a-n s -. __ -�_ := (� � • ' ❑ Commercial ❑ Trailer Court ❑ Motel Ot -- :- ;:___ :_ _ Installation:will serve: �3 esidence � Apar#mer. House - r Number: Garbo e.Grindex-- Lot Size-----,- --- C Y' ~ N�mber ofi living units:-_ -_I� of bedrooms` g fi i eAn Water Supply: Public System and name-------- -- """"-- ---- I Loa rlvat I` , p Character of soil to a depth of 3 feet: s Sand ❑ Silt ❑ Clay ❑ ; Peat ❑ Sandy Loam ❑ 'Cay .m : F Hardpan F-1 Adobe:❑ Fill Material__.----------If yes, type----------- ----------- ; (Plot plan, showing size of lot�i[location of system in relation to wells, buildings,_etc. must be placed on reverse side.. _ NEW INSTALLATION: '(No.septic"tank".or seepage . permitted if public sewer is available within 204 feet,] Cr it -Q�- ---- '-----Liquid Depth. -- ----------- PACKAGE -- - = PACKAGE TREATMENT- [] Size" ; 9 j r k I . _ _ -__ _ _-- Material '= {--.__' No. Compartments € Di sance'to nearest: Welpe-------- — `------ ------Foundation.._ ------ Prop. Line ------------- ----- -' b i g . .. ` LEACHING LINE No. of Lines;--:---------- ------'--,:-_--Len�f�each lirtis._ Total Length : . �• Filter Material ---------------- pe Depth Filter Material ..... - _ ------- - -Distd�nce to.nearest: eI L_"\--------f-J---- _ Foundation n ------'------ --------- ----------- n ,.i:.. _.,. _ . .,.. ... Y.. ;.. _.Pro erty in - .. � - � i -�-� Rock Filled Yes No❑ De th Diame =-;,r- - --._Number--------- ter— = - i SEEPAGE PIT [ l P � Rock size te == 1 --------------------------- - Water Table Depth-------------. :------ ----- 3-./------;---- . ; Distanceto `. �-- u --------------Prop. Line- ----- -------=--- s REPAIR/ADDITION:(Prev. Sanitation Permit#------- Date =-----= ' `.:� Septic Tank (Specify Requirements)- t__-- Y pq Q� , Disposal Field (S ecif Re uitements) --- - -- -- -- . p ., _ dh � t fig. � . I, °=� w�, y.•.(D-ra.w=Existing and•required additionn reverse side] . i � I hereby certify that I have p'repa ed this application and'that the work will be' done in accordance with San Joaquin County Ordinances,L State Laws, ani Rules, and 'Regulations jof the San i"quin Local Health District, Home owner or licensed agents si nature certifies'the followik g ' - t 66 1 certify thaVin the performance 'of the,wo k for_WK1c #hisLpermif s issued, I shall not employ any person in such manner as to become`su ct to Work an''s CoMpensation .laws of California." 7 ' Signed\ t --- --- -- --- - Own � 4 �� ` #I } ``h.y - -.----- ',, L,, _ ,LTi. e_ rk (If"ofhePthan' ban ner). ; i + FOR DEPARTMENT USE ONLY ----------- e, DATE ---------------iBYi -_ ------ -= - ----- = '' # DATE - --- ---- -- ---- -------- DIVISION O :LAND,NUMBER.APPLICATION ACCEPTED ADDITIONAL COMMENTS---�� -7-7--_ w'-,,�- - -- --- : ) " "T _ - ""," ""� -- ----- --- ' - ,��w ------ ----- - ----- -------`--------- ---- r ------------ - ----- -- _. i ___- ---'`-r- _ Final Inspection by:_!/t/. .- ..� -------- ---------. �------•---- r&s 21677 REV. 7/76 3M EH la 24 SA JOAQUIN LOCAL HEALTH DISTRICT