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FOr4 b-,PFICE USE: FOR �S`FFICE USE: t: „ APPLICATION FOR SANITATION PERMIT ------------------------------------- ............... (Complete in Triplicates Permit No.,2.. ..._.1_�. .-- --------•--•----------- -- •--- ---- ----- Date lssued..:2-:c?-c7!:7 ......................................................... This Permit Expires 1 Year From Date Issued I 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: JOB ADDRESS/LOCATION. QS.... .-.- iwiY Y srK. .--------------------...----..-..CENSUS TRACT Owner's Name...-.PETE. L!�7�tJDSO.(J - - ------- ....... ...................•------......:............... _..yy�.�'..... Address... City... --.--.. _-Zip �d ` - '3 Phone r.96o Contractor's Name.. rLI�fIsH_..-d".. o:fJ.S License #.a � - 7 Installation will serve:` Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other------------------ --------------- ---• ; .. f Z Number of living units:`,_-/..,w_...-Number,of bedrooms....�-.=Garbage.Grinder.-------....Lot Size----------4�....X..L..-.p............ . .. .. Water Supply: Public System and name- ....-C/..ry_ ...: :=__t_........ = -== ..,- :----....Private ❑ , Character of soil to a depth of 3 feet: Sand ❑`Silt❑ Clay,C] Peat ❑ Sandy Loam ❑ Clay Loam ❑ 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: (No septic tank or seepage'pit permitted if public sewer is available within 200 feet,) O PACKAGE TREATMENT [ } SEPTIC TANK [ ] " r Size------- ------------------------------ ...------.--Liquid Depth...............-----.......t i5V ST1N6 Capacity.......... ...........Type---------- Material------------- ---No. Compartments-------------,...----------- - •-_. i Distance to nearest: Well---------------=-------------- Foundation----- -- - ------.-------Prop. Line--.-- _--- ------------ LEACHING UNE [ ] No. of Lines.............. .......Length of each line ....... -_._.. .:.rTotal.Length ._ ------------- EKI57-11(11 'D' Box......... -Type Filter Material.............. . Depth Filter Material--------------- ...... ...------- --------.--- Distance to nearest: Well--'--------------------.....Foundation----_-------...-..........Property Line...--------------- ...... .. SEEPAGE PIT [ ] Depth....... ....Diameter.....:....... ------- Rock Filled Yes No ---....Number - ---------'---•-=--•-- ❑ I Water Table Depth.. ................ } ?-i----- - -----------.......Rock Size------------- Distance to nearest: Well.................... ..............-------Foundation--............... ..-....-.Arap, Line . - ------------.-- -... �REPAIR/ADDITION {Prev. Sanitation Permit#--------/4Q. r� / ate --.. } Septic Tank [Specify Requirements)---- --------------------------------------- ---:--......---=--... --•--- --------- ---- ....------= Disposal Field (Specify Requirements)...EwSr�LL-.3 X d �-_f? T.... �..,, o-- -L/-- f . i ------------------------------------------------------------------------------------- ----------r =:------------------- _..... �. -•--------- -------------------------------------------------- ------------------ - ----------------------------- -----------.----------------------- ....... {Draw existing and required addition on reverse side} I hereby certify that 1 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, dome owner or licensed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation Iaws-of California:" Signed--------- - - ------------- --- ---- --------------------------- ...Owner- B ..... 2r>rp ...............Titsa--- -------CS-T�i?'tc---7`� ... (If other than owner) FOR DEPARTMEtiT USE ONLY APPLICATION ACCEPTED BY... -------- --- .DATE ....Z�ZZ .71� DIVISION OF LAND NUMBER.....--- --- ---------DATE.... -------_------ --------- - ------------- ADDITIONAL COMMENTS... - - ...- ... - ...... :. �.��- ::: :: 7� --------------- --------------- ----------- ----- ------ ----- 3 ......:---•--. - ------ ----- -- --- r....... -------...... --- ------ --- FinallnsP61on by: . ..... ......... A_ -------------------------------------------Date...�J ~7� :... .---.- ----- EN 13 24 4 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21577 Rev. 7./76 3M