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FOR OFFICE USE: FOR OFFICE USE APPLICATION'-FOR SANITATION PERMIT ti: ------------------------------------- -------------- (Complete in Triplicate) Permit No..77-7 3 - ----_------------------- This Permit Expires 1 Year From Date Issued Date Issued3:�Z7.-" S Application is hereby made to the San Joaquin Local Health District for a permit to construct and.instal�l tl ee work rein descri ed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB,ADDRESS/LOC� � ATl 60-r-- - -•- -- -- ----- - _ ( , .,�- .�,R o�--- W ----------------------------- CENSUS .TRACT -----= --------- Owner's _ ------- - -- - Name. 0 'j42 - Address------------ ------------ ' ----- :---Phone. ' _ _.._city=. ._ _Zip--- Contractor's Name_.._____..._ _ - _. ense # 7 Phone i Installation will serve: f, .'Residers Apartment blouse ❑ Commercial ❑ Trailer Court ❑ ( w �.+ ,i.. . ` i rfillotel ❑ Other_ l � r1 Number of living units:___>____�__- Number.of.bedrsooms__._�__--Garbage Grinder_- ._____ALot:Size___. --------- - --- Water Supply: Public-System and name___ .. r ----_- - ---- -------------------- - - Private------ ---------- :--- -- - --- Character of soil to a depth of 3 feet: Sar d. ] 5ilt[]¢Clay 03, Pe.fi _ Sbndy-Loam ❑ Clay Loam ❑ Hardpan �'`�A obe �--Fill Ma eriah .._lf yds;te= _ _ t ------------- ==4% (Plot plan, showing size of lot, location of system in relation-to wells,�buiQd-Ags;etc:.rriust be place bn reverse side.) NEW INSTALLATION: (No:septic-tan �,orseepage� pTt Tfirmitted if public sewer is available.within 200 feet,) PACKAGE TREATMENT v],'A �� s 'j'max { E 1 �S �1 4TANK '.[.t a wSlze------------------------------------------------- ,u - --7-- \ p ------- � .� �. i it � ---- - -- --Liquid De th.-- Capac :_s .__-- :Type'=' t- Material =-----------------=- -No.'Corrrpartments------- = = I I , + ,' tea ! t . Distgnce.to nearest Well E -i-- __----. --- -----_ --Foundations t_ _.__l..-Pro . Line-------------------------- LEACHING LINE, E[ ] No, of Lines : -. J--._ -Length.of each lina-- j___ Total Len th _p------ ------------ U . t- f i - '; ,� g. -- - - D"Box---- - -- ype Filter M� terial_--------- --------------------------- ---.Depth-- Filter�M'aferialt - # t , Distance,to nearest: Well- --------------------------Foundation---------_ ------ -----_- 1 _.. f - - Property Line _ t .. f l Depth ': Diameter-1 Number i Rock Fill-d ._Yes ❑ No SEEPAGE PIT i Water Table Depth. ------=------=------.--- Rock Size------- ------- t---=------------ 'Distance to nearest: Well----------------- -------------------------------- Foundation--=---------------------..Propt. Line--- ------------------ REPAIR/ADDITION (Prev. Sanitation P rmit#___________________ `_ '_ _ - f -------- Date //pp ------_-- 0' ' __------- , _�� -- ----` A 1Septic Tank (Specify Re uirements1__ �. r Disposal Field (Specify Requirements). Ll'-..____- -- ------------ ; ��;, ------------- ------------------- _ - (Draw existing and required Addition on reverse side) * s ! 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 I signature certifies the following: "I certify that in the performance of`the work for which this permit is issued, I'shall not'emlo" an p y y person in such manner as to become subject to Workman's Compensation laws .of California." 5igned ------------------- vvner Title will,"9t.her than owner} y 'FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED; BY \;,j "A DATE_y_..;TE- s f - --------- DIVISION OF LAND NUMBER ' - --- �i i �" - ��-- ------------- DA ADDITIONAL COMMENTS-------- `- - _ ____________E__---_-________--_-__--.-_____-_ 't !j- __________________r 4_ .. ..____ _ ___________________________________.___---_. 1__. - .. _ Final Inspection by:-=-- - �-'=' = � ��1 SAN ----------- --- ------------------ - - - -- ---- -- -------- --=G�c �-:- -- --- --'--- -_._._Date.----=-t"" ------�---- ----- ----- - -.. -t EH 13 24 JOAQUIN LOCAL HEALTH DISTRICT Fes 21677 Rau./Wb 3M