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FOR OFFICE USE: APPLICATION FOUR SANITATION PERMIT FOR OFFICE USE: ------- (Complete in Triplicate) Permit No_ `7,f--a-Z. ---- .. -------- ----- This Permit Expires 1 Year From Date IssuedDate Issued ----- 7,f Application is hereby made to the San Joaquin Local Health District for a permit to construct an'c instll the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JO77 ADDRESS OCA ONS.- &___7 ,-- 4 (/!� 6_w_N 7Y __ J_ .CENSUS TRACT Owner' ame__ i ` Address_ = hone -- .,,� �' Cite -- - ----- --------------- -- Zi :... E k... _ p Contractor's Name- -- -- ------- -- ----- -------------------- - ---- ----License # Installation will-serve: R'•. �1� _ Phone--- esidence Apartment House❑ Commercial ❑ frailer Court ❑ ' Motel ❑ Other--- Number ther--Number of.living.units: _-_! _Number of,bedrooms. g ` Gar.ba e Grinder.:_ __...'-Lafi.Size_..._- ----- ./ ] Characterofsoil to a depth of 3 feet: Sand [ Silt❑ C Private ❑ after u Public S stem.and name-_-.-____`__-.- _- .[ ____ __ _ ___ ___ ------>=---- --- ------------- ------ _-.- �� _0_ lay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe Fill Materia! -�""�-• �"-�-•- • •' '- If Yes, type--------- ------- -------- ; (Piot plan, showing size of lot, location of system in relation to,wells, buildings, etc,must be placed on reverse se.) NEW INSTALLATION: i ' '�• • - ` . � id (No septic tank , :pit permifted,if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] + SEPTIC TANK- [`]—t--�--�-t-Size ------------- t __ _ __ i ) i ) -------------- Liquid Depth--------------- Capacity------- ---Tn'TY.p, =^ Material .- Compartments# n ---- ---------------------- ..Distdnce,to nearest: Well ..> r_-, ?_ ,Foundation._-_�o- = Prop. Line_8_.____ _____________ _ _ i max_ .___. .' 4 # LEACHING LINE o � a [;] Na. of Lines _.: -- - - f each line =- -- Total Length----- r r `D' Box—-- --- Type Filter Material---------------------Depth Filter Material---------------- _.____.____- 1 ° '. _nd. SEEPAGE pl. Distances to nearest: Wel! ----------------- ----------- i Fou at � -� _ :.. .;.:_�...�6 n - --- ----------------- rope 4ty 1ne T ;. [ 1Dpih Diameter -------------------------- ----------Numb ' x ! _...! Rock 1 t3 oc Ye ❑ N Water Table Depth `: ------------------------------ Ro S ck ize... � s o� [^ stance to nearest: Will S.. . _ . ation Prop. Line ? ) Found REPAIR/ADDITION Prev: San'itatlon Permit#_ _—�-- { i ) 5 t Date .__ u ------- ] } 1 Septic Tank fS ecif Re virements _ V p Y, q. 1 �-l11�- �i��=- j Disposal Field (Specify R Requirements)______________ __ __�r--� - -- i G - "` ------------- --------------------- ---- ---- ----- ---- t` i--------------- --- . -- ----------- --- lam. ------ --- - -- ----- [Draw j. - -------------------- --- t [Dr'aw exi-sting•-drrd required add#tion on,reverse side)¢ j I hereby certify that 11 have prepared this application and that the--work will e+,done lin accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of;the` Sari Joaquin-Local-Ftealth�istrict. Home owner or licensed agents ' F �. . signature certifies the following: "I certify that in the I p ormance_ 'the-Work_f ch-t�his-permit is issued, !'shall not employ any person in such manner as It to be o ubject ork n's ompens on; ws of Cpliforr;ia.',. ,.,<g ed t s ;, ------------------- _ I _.. --------------- Vvne --------------------------------------- ' Title [If other than owner) t - ^FOR-•DEPAR -. ENT•1JSE-ONL•Y, APPLICATION ACCEPTED. BY_ ___ DIVISION OF LAND NUMBER .-.._ . _ - - ---------------------------------------------DATE.-------— .. - ._ r-- ------ ------ ---- -- -- ADDITION L CO ENT -- -- .. - DA E - -- f , f' " -----------------------------------------------�----` : --------------------------- Final Inspection b ----------------- ----- ------------ --------- EN 13 24 �� = Date G -------- SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7176 3M