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FOR OFFICE a✓ APPLICATION FOR SANITATION PERMIT ... .:.......... �' 966 " (Complete in Triplicate) Permit No..�......--- ------------ --- This Permit Expires 1 Year From'Date Issued Date.Issuedc .: Application is here�apd��,n uin Local Health District fora permit to construct and install the work herein described. This application is compfionce with County Ordinance No, 549 and existing Rules and Regulations: JOB AbDRESS/LOCATI0N... DI4.T�...- . J ,: . .CENSUS TRACT.. . Owner's Name.-_..'el' .�......+�F_..��J� ................... aa-.: . . .. ...._:Phone4?Z3--lav_... Address- d 66/ �[J ...SIG-�, city r - --- .......:............ y./�/ .. Z':P----•--- ` Contractor's Name # 17 Phone. ., �-. Installation will serve; Residence ❑ Apartment HouseComm rcial ❑ ❑ Trailer Court ❑ -Motel ❑ Other.�� ,- e9�1/C',rs�i Number of living units:, .... ----------Numb er of bedrooms.....-.__ .Garbage Grinder............Lot Size.................. Water Supply: Public System and name__ -4�T yy� ..y--- -- -Q l*i/l..- -------------- ... -...-------= ---- -.-- •-----Private . Character of soil to a depth of 3 feet: Sand Silt ❑ Clay ❑ Peat [] Sandy Loam ❑ Clay Loam ❑ Hardpan .... : - p ❑ 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 pu lic sewer is available within 200 feet,] r PACKAGE TREATMENT [ ] SEPTIC TANK 't Size _. .. -�-�----- ----Liquid Depth•.--'�..�j„--------- ~\ Capacity.. 'P ype;F,04.�377Materia]410r' :No. Compartments. - - LEACH]NG Distance to nearest: Well-- --------=---__------ _... _-Foundation..- .. - --.Prop. Line- - - � - - - --� -- ----- -�-------.. LINE No. of Lines --.- ----- ----.Length of each Tina.....�Q.�_�'�_- Total Length �� ...... D' Box��._...Type Filter MaterialR-46epth.Filter Material__ -, ---- - . SEEPAGE PI Distance-to nearest. Well-----.--•------- .-- -.._-.Foundation.................. ..:....Property Line..-------------- T I ] Depth.--.,-.....- Diameter....................Number- - -------•--------- Rock Filled Yes ❑ No Water Table Depth--------------- Rock Size................._._ Distance to nearest: Well- -----------------Foundation. Prop. Line............. REPAIR/ADDITION (Prev. Sanitation Permit#.---------._..:. -. Date--_-,-.- ..-.•-_ .... . Y Septic Tarik (Specify Requirements)..__ ........................... ---------------=--- ........ Disposal Field (Specify Requirements)_......._....... ------ - a... ------------------------- ------ : - ------------------------ ------ ---- ----- --•--- , (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 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as l to becomg &wbject to Work an's Co pensation laws o California." _ Signed . e<G yc........Owner BY ........... Title..--- -- ll other than o F R DEp RTMEN USE ONLY APPLICATION ACCEPTED BY /jsz .. = DATE DIVISION OF LAND NUMBER. .-------- -- = ----------- DATE... ..... .................... ......--- . -- ADDITIONAL COMMENTS. ..�0-?? ,�,.. �� m ti ..-G�+i �.� -......�.�.. A.G(L47745- ........ i-16-: .g... � . .-T. .rt ..... t .. . .�►-.. . icy. .--. L� -- -- - O/c, -- -- ----------- ------- -------------- - - - ---- -------------- -- . ................... .............i Fina! Inspeciion by:.. ---- .l ---- -- -� -------------------- ---------- - -- ---------- -----------------------. .....Date__.. ---�-----. - -7� EH 13 44 F77-_P-EV. 7/7 3M SAN JOAQUIN LOCAL HEALTH DISTRICT `U►"