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C FOR OFFICE USE: FOR OFFICE USE- ---------------------------- SE: APPLICATION FOR SANITATION PERMIT ------ ----------__-------- Permit No._ 71...-:.1e (Complete�in Triplicate) This Permit Expires 1 Year From Date Issued Date Issued.___�`��= 7J Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. I This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: P JOB ADDRESS/LOCATION_...._/_�S___�K__o0_ster.;Rd----------700_' 1V_, _Dur-1Tam-_ferry_:Rd..___.CENSUS.TRACT._2.5.5._=140 _Q-.__. Owner's Name.- o]1Rand ROb_ez ;BQ get i ,. .. Phone ..x_3.7-.3.$.83 - _ _ :Rd.- - ------ ----------- Address ------- - Address.- 3S59Shiloh Rd.--- --------------------Ci Mode.St o - ------------------ Contractors Name _ t -------- ---------------- ----------------- - - ' Liens #_ --�-F`-----� ----'- PhoneZ__i P____-9--_-$-•_-3--5_-1-` serve: Residence Apartment House. CommercInstallation will' Trailer Court _ _ Motel [❑ , Other---- ------ ----- -------- ] ---------- t- e •. . Number of living units:--�------_------Number of bedrooms.._Z. ___.Garbage Grinder.-a.--------Lot. Size-----'--------------- _------------------- .._-_.._._._:__ Water Supply: Public System and name--::: .: - ? ` .------=------------------ --------=--_--- --------,-.-_. F.,-.----------------- ------Private' Character of soil to a depth of 3-fEet:-=--S6nd-- il# ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam X - Hard pan-O.,�.Adobe.❑.-. Fill Material------------If-y.es,.type------.------ - - _ l h;i° its :i. 1._ \1•-,'�•-^�l } (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 sevver'is available within 200 feet,] PACKAGE TREATMENT [ ] 'F SEPTIC TANK q p [),Q Size - = Liquid Depth ------------ Capacity-- Type------------- -- ---- Material - =No. Compartments--------s71------z�- Distance'to nearest: Well- 1.fl _.f:�__, _ -__oundation---------------------------Prop. Line--------------- ------- LEACHING ------- -_--.- LEACHING LINE [ ] No. of Lines___.-..___3__ ______ .-______Length of each line---------90_.__„__,___•__.Total Length.2.7-0___-___------- - - - . „ R. . i 'D' Sox.- ..._-_----Type Filter Material--------------------Depth Filter Material------------------------------- ' t 3331 Distance:to nearest: Well_;__10_Q_. f t_.------Foundation---------------------------- Property Line-__.__.✓ .___ _ �. SEEPAGE PIT [ ] Depth----------- ---Diameter-]------------ ----Number--------------------------------_ Rock Filled Yes ❑ ; No Water Table Depth. '•----------------------------------------- Rock Size. Distance to nearest: Well-------------------------------------=--_-.Foundation-------------------- -- Prop. Line_- ----.-------;-- ------- REPAIR/ADDITION (Prev.' Sanitation _________ ---------- ---- ----------- Septic Tank (Specify Requirements)_____---- - Disposal Field (Specify Requirements)__ --- -----------------------------------------------------7------ -------------------- ------------ -----------•---------- ------------- ------------------- ------------ ----------------------- - ' -------------- ------------- - {Drawexisting and "required addition_on reverse side).. _ hereby certify that I have prepared this application and that.the,work will -be done in accordance with San JoaquinyCoun Ordinances,: State laws, and Ru}es and Regulations of; the San Joaquin Local Health District, Home owner or licensed agents signature certifies the following: i "I certify that in the 'perforrriance of the'work for which this permit is issued, I shall not employ any person in such manner as a to become s t to Work Compensation-laws .of California.” _ Signed__.__ ---------- f iVIP B ---------------- -----'-- '--------------------------------------- --- Owner Y= - --- ----.-----:-,-------------------- ------------------------- I (If other than Towner) r ) -FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED. BYti - DATE------ ,_—af=�r7 DIVISION OF LAND NUMBER---------- ---- y --- ---------------------------- ADDITIONAL --------- DATE l ---:-- -- - --- ------_-- ADDITIONAL COMMENTS-------- --------- ----- ----- -~'=------------------ = = = i _ _------I- _. __ ---- �. ._. .. - . --- -=--------------- --- - -� ---- = - ---- - - - - - - -- Final Inspection-by: .-. . -- - --- ---- _ -- = Date �---7 -------------------- EH -- - EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV, 7/76 3M J