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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 --------------------------------------------------------- (Complete in Triplicate) Permif'N-o------------------------ ----------------------------- ----------------------- Date Issued_ 7J?7/ ...........--- ._- --------- ----------- This Permit Expires I Yeew-From D04,t4wo 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------1-6-2A-----._.._R&o --------------------------------------------- -------------------------CENSUS TRACT---------------p-------------- Owner's RACT--------------- ----- ---------- Owner's Nam t.-----4- _oo_Is---------- -------------------------- -------- ---------- ------------------------------Phone-- Address------- Rfre------------------------------------------------------------- ---------------------------City___Skev---M�wl%)-----------Zip------------------------------ Contractor's Name__(3� -bt-le--------------------------------------------------------------- ----License #--,;' 3_77T------Phone------------------------------- Installation will serve: Residenceeo Apartment House 0 Commercial 0 Trailer Court E] Motel ---------------— _1? ----------------- Number of living units:-----I----------Number of beclrooms_i�2-------Garbage Grinder-------- ---Lot Size_-____*-____________________________________ ---------------------------------------------------:§ Water Supply: Public System and name----- ?,V vs ------------------------- ----------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand E] Silt[] Clay E] Peat Sandy Sand,y Loam 0? !Clay Loam E] Hardpan F Adobe ❑ Fill;Material------------If yes, 00..____ _______________i___.-__ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placid on reverse side.) NEW INSTALLATION: (No septic tank or seepage sewerCP P71 __P_e_r_m_Tff&_d_iTp`Gb1-ic— �is-a-'�6-iTp-Fewithin 200 feet,) PACKAGE TREATMENT SEPTIC TANK 'Size-------------------- ----------------- -------Liquid Depth------------------------- Capacity---------------------Type--------- -------------Material------------------(0'-�f No"I .; Compartments----------------------------------- Distance to nearest: Well___________________________________-___--FOUnclatiq_�_ _.1// --------------------Prop. Line----------------------------- LEACHING LINE No. of Lines________-_____________ Length of each line.____-_____-._ f/----------Total Length._______----________--______--_____ -C_ 'D' Box------------Type Filter Material--------------------Depth Filter�aterial----------------------------------------------------------------7� Distano*to n-e&est: -------:-:i-----Found ----------Property Line---------------------------------- ----_Number_____---- --------------------- Rock Filled Yes F iter-SEEPAGE PITNo ❑ Water Table Depth---I------ -------------- ------ -------------- _Rock Size'---------------------------------------------- Distance ize'-------------------------------------------- Distance to nearest: ell-L.-- -- ----- --- A-------------- ------Foundation--- -- I-- -------------------Prop. Line--------------- ------------ v . REPAIR/ADDITION (Prev. Sanitation Permit#1L- - D6*_ ----------- - --------- ------- ---------------------------------------------- , 4u Septic Tank (Specify Requirements)------ ------------- --- --- i------1-1-- ) 7-w Y, ----------- ----------------- --------------------------- ...... - ---------------- Disposal Field (Specify Requirements)- ---------- --- ------------ - - - ----------- ------- --------------- ------------------------------------------------------- -------------------------------------------------------------------------- -------------------------- -------------- ------------------------------------------------------------------- ----------------------------------------------------- --------------------------------------------- --------------------------------------------------------------- (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 Son 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 to become subject to Workman's Compensation laws of California." Signeclaw., ?I-------R--------- ---- --------- - ---- ----------------------------------Owner By------ ----------- (E------------ --- --------------------------------Title------------------------------- --------- --------- -I (If other than a r) DEPARTMENT U ONLY APPLICATION ACCEPTED BY -- - ---- -----------------DATE ----—-- ------------- DIVISION OF LAND NUMBER --------------------------------DATE------------------------------------------------ ADDITIONAL COMMENTS--------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- ----------------------------------------------- -------------- ----------------------------------- ------------------------- ------------------------------------------------------------------------------- --------------------------------------- --------------- - ------------------ ------------------ - --- -- ----- - -------------------I-------------- ----------- Final Inspection by:------------------- - -- - - -- ---------- --- - ---- -------Date--- -------- 1H 13 24 SAN...1 J"", OAQUIN LOCAL HEALTH DISTRICT Fes 247 REV. 7/76 3M