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F... FOR OFFICE USE: �~ �A FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---:`------------------------------------------------ 7G SLMc mp ete in Triplicate) Permit No._7 � l� Date Issued_-6'1� I� ,,+ yhils Permit Expires 1 Year From Date Issued 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: p JOB ADDRESS/LOCATION-----40T_____.A G_L_ ------Sue-tree..............-S�_.r.__R/°VCS'---��p�ENSUS TRACT------------------------------- Owner's Name------- oY-gW----- ---)5 s,* --------------------------------------------- ----------------------------------Phone---------- ---------------------- Address ��GIoQ--------- _�9SSn/Y- - --------------------------Ci ��'�1_G._ Zi `------- tY P +� /�� --_License #1--- � ------ --------Phone- -----------�---•, Contractor s Name------ -` �YTI�t�I1r�y -s _384 S'�.3-N2./ \ Installation will serve: Residence® Apartment House.❑ Commercial ❑ Trailer Court ❑ a Motel ❑ Other---- ---------- ----------- Number of living units:-_.._l---------Number of bedrooms----/.__.---Garbage Grinder------------Lot Size-__:-_-_-------_------------------_---.----_-_-_--__- Water Supply: Public System and name------------------ J.__R�- __-- -Private E]- --------------------------------------------------------------------------------------- Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam W1 Hardpan ❑ Adobe ❑ Fill Material----------._If yes,type-----------------_____--------- v� (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,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size-----------------------------------------------------------Liquid Depth---------------------------- Capacity_- ------Type PYC_<A' V_T__Material-_Co.&_c-_----_--No. Compartments------Z---------- Distance to nearest: Well._-____-_-_________________________-___Foundation--____1_0- -_-_ —_--Prop. Line_-_ `__________-_ a LEACHING LINE [ ] No. of Lines-----------------------------Length of each line.------------ -----------------Total Length.__-_------_------------------------- F;'/_Te y j3 'D' Box----I------Type Filter Material-----go4A----Depth Filter Material------%Za"___.-___-____-______-_--_-_-____--__--__- Distance to nearest:Well --------_-• ----____-_ ----Fountfation --- - ------ ------------------------- SEEPAGE - - --- --.SEEPAGE PIT [ ] Depth----------------Diameter--------------------Number-------------------------------- Rock Filled Yes ❑ No WaterTable Depth---------------------------------------------------------Rock Size------------------------------------------------ 1, Distance to nearest: Well----------------------------------------------Foundation--------------------------Prop. Line--------------.-------___._. REPAIR/ADDITION (Prev. Sanitation Permit#-_--------_--_-------_--___------___---____-_.Date____----------------------_------------_-_-) SepticTank (Specify.Requirements)-------------------------- ----------------------------------------------------------------------------------------------------------------------- --------- Disposal Field (Specify Requirements)---------_------ --- _-__--_-_----__--------_ -__-----__-_-_- (Draw existing and required addition on reverse side) 1 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 to become subject to Workman's Compensation laws of California." Signed---- Sa� - ------- -------------------------------Owner By-------- ---� ----- ------------ ------------------------Title-------------------------------- r than owner) FOR DEPARTMENT G E ONLY APPLICATION ACCEPTED BY-------Z:: -- - -- ------- -------------------DATE DIVISION OF LAND NUMBER ------ ----------- ----------------------- ------------------------------------------------------DATE--------------------------------------- ADDITIONALCOMMENTS-------------------------------------------------------------------------------------------------------------------------------------- ---- -------------------------- i ------------------------------------------------------------------------------- • ---------------------------------' -----------------------------------------------------------------------------------------------`--------------------------------------------------------------------------------------------------------------- ---------------------------------- ---- -- -------------- - ---- Final Inspection by:---- --- - -------- ------- ---[�- �-----------------------------Date- -- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M r-�