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FOR OFFICE USE: A azc <br /> - ------ �• _---- � AFOR SANITATION �� � F � <br /> ' PPLICATION ION PERMIT OR OFFICE USE. <br /> A------ [Complete in Triplicate) ,� Permit No --,s <br /> d <br /> ='---"-------------- - _ ' w : . <br /> --"This Permit Expires 1 Year From Date Issued <br /> •_ Date Issued_ -�/„� <br /> Application is-'hereby made to the San Joaquin Loccdl Health District for a <br /> `This application is made in compliance with County 0 GIf nce Nod 549 and'existing o Rule <br /> permit to construct and install the work herein described, <br /> 4 ' " •- i - <br /> � - sand Regulations: <br /> ._ g <br /> JOB ADORES$/LOCATI N-_' r- <br /> --- <br /> •` _ <br /> tet' --- <br /> Owner's Name.= - <br /> NSUS TRACT <br /> Address_- t ---- ' I ------- ---- ------ <br /> Q3 --- - --- - -- - _ <br /> i :. --- --P h <br /> on <br /> .Contractor's Name. - ,---„ ------------- -- _ _ <br /> City - - <br /> i 4 <br /> ----- ----------- <br /> Zip_ <br /> lnstallation;will'ser`ve: � - - --------=License `,3� -- ---- - - <br /> Residence , . <br /> Apartment House.❑ :Commercial � one_._ �.._-'_- -- --- ---- - <br /> . � h �s <br /> ' .. } Motel <br /> 0 Other---------------------- <br /> Number - = r;: Trailer <br /> _ iter Court �] <br /> of living_units:-__ _�------Num:ber of bedrooms._ <br /> } <br /> + _ 1 ----Garbage Grinde':_?--.---Lat Size__- r <br /> Water Supply: Public System and.narrie----'---------- - ' { <br /> - - <br /> Character of soil to a depth of 3 feet: Sand - - <br /> R '.- <br /> T p Adobe❑ FilM a erial_ Sand Loam Private 1 <br /> .-.Hardpan _ <br /> ❑ Silt y❑ Peat <br /> . ,-.. . ._.. 1 f D,e . ... Y Clay Loam � <br /> Y tYpe---------' <br /> (Plot pian, showing size of lot, location of system in relation to wells, buildin,gs,'etc. must be lace <br /> r NEW INSTALLATION-— ' ' - <br /> {No septic tank "or seepage . it - A-- •.. ,,,.�..,. Placed on reverse side.? �- <br /> PACKAGE TREATMENT { P Permitted if public sewer is available within 200 feet,) <br /> I I : SEPTIC TANK [�� •- / <br /> + Size_.--7 <br /> ! Capacity/a_06___ `TYpeV �� Liquid Depth. <br /> _ --.Maternal.__:-- _ --- - - <br /> Distance to nearest: We1.L._ '�! f f o ,mp rt <br /> F m <br /> ---=------ -= ants- <br /> No <br /> LEACHING LINE. a” <br /> ---------------- <br /> .. fGY No. .of Prop. Line_ <br /> -.. :Length of each linc+._'yd-::y0- �/� <br /> _ oP ,� ./�cc�Jv <br /> D' BOX .� T ' I , _-..Total Length �p20 <br /> t.. ype Filter Material <br /> 4 p -----.- ------ <br /> 15.e <br /> - Depth Filter Material <br /> _--,_-.. Q--- ' <br /> �. <br /> Distance to nearest: Well --.Foundation-_-,cr2 �- , -� � <br /> SEEPAGE PIT . . ,..,. ! ------- - <br /> 7 <br /> {' Depth � Diameter_;-_ p _ ---------- _ <br /> 33 �/1P party <br /> t .. Number Line. - -- <br /> ble De <br /> Water Ta pth---'----��f� � � . --: --- -- - <br /> Y Yes <br /> -------=------- - <br /> ii Roc No ❑ <br /> j ---• -- , _ Rock Size._-- .. - <br /> Filled <br /> Distance to nearest: Well._'___®Q_e <br /> :Foundation-_ Q <br /> REPAIR/ADDITION (Preva Sanitation Permit#__: - <br /> Prop. Line S1 <br /> . Septic Tank (Specify RRequirements) # 4 <br /> - - ----- =---- --Date_.--- �'--_-- ----E--- ------'-------- <br /> { P y __.--__-_-- <br /> . �. <br /> Disposal Field S -- -�-- --- - '' 1 <br /> (Specify Requirements): ; <br /> ------------- ------ ,. _ ------------ <br /> ------ <br /> ----------- <br /> -- <br /> - ------------------- ----- <br /> ' - ; <br /> { = --------- -'. - '--------- ----------------- <br /> hereby`certify that I have prepared thiDsrappl cation and thsting and at required <br /> addition <br /> o k1ON�j+nhreverse side) ..' <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District• Ho - <br /> e done in -accordance-with San Joaquin Count; <br /> signature certifies the following: <br /> Home owner or licensed agents <br /> "I certify that in the ` <br /> performance of the:work for which this permit is issued, I shallinot employ an F <br /> to become object 1-to.W kman•s Compensation�pensation:laws of California." <br /> Signed-- -_ -- son such manna <br /> '-- - M - <br /> person n <br /> BY--- Owner f- : <br /> --- ----------------- <br /> ------ -. <br /> ` f l <br /> -" Title _ "--y`---,---- -'r�J <br /> i <br /> l (If other than 'owner) _ <br /> ­10 'FOR DEPARTMENa <br /> APPLICATION ACCEPTED T'LfSE ONLY: <br /> BY_ -_-- �`-- <br /> OF LAND NUMBER------------- -------------------- <br /> DIVISION / <br /> . TE._ ->--3-------- ------------- <br /> ADDITlQNAL COMMENTS =. y - .- DA <br /> TE- <br /> = = ----------------- <br /> -------- <br /> - <br /> --- ------- <br /> -------------- <br /> -Z-- : <br /> -� - - '�-- <br /> - - <br /> ---- <br /> --------- ------- <br /> Final Inspection b Date.-EH 13 24 SANJO Znc-- ----- -- ---- <br /> UIN LOCAL HEALTH DISTRICT <br /> F&5 21677 REV. 7/76 3M <br />