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h FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------------- Permit No.�$-�-- '��-g (Complete in Triplicate) -------- - --------------------- --------------- 4 Date Issued./-r_342_?��'e _________________________________ -------------------- This Permit Exp4s 1 Year From Date Issued .__„_ Applicafion i6 -made to the San Joaquin Loca!`Health4D.isYrict dor-'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:_ i - yy _ ------ ---- ----CENSUS TRA CT--------- ---------------B ADDRESS/LOCATION.... ------------------------------------ Phone ✓" honeOw� ner's Name.. ---------- -- - - - t --- -------- ------------ --- --- ✓ � fAddress---------- --------- ------- Zip Contractor's Name_ _--License # _ --.r- --�f-Phone " - -- Installation will serve: , Residence Apartment House E] Commercial E] Trailer Court ❑ i . Motel ❑ Other ----:---=--=--------- ---------- -_--- br of bLot SizeNumber of living units:_ .f _-____Nume _ - - ----_ Water Supply: Publ ------� -------------------- ------- ---------- -------- ------------- ----------Privateic Sy�te 'a � ❑, s{' Character of soil to a depthaof 3 feet: ' Sand ❑ Silt E] Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ I elpon ❑ Adobe,X, Fill Material__._ y 1 (Plot plan, showing size&1. t, location ofrsystem in relation to wells, buildings, etc: must be placed on reverse side.) PACKAGE TREATMENT SEPTIC TANK 'pit Rer i d�iublic sewer`}is available within 200 feet,) NEW INSTALLATION: {No septic to^NK-�[,j, f-S Si -- --`' -- P. -----------Liquid Depth-------- ---------------- [ 1 f .Po . Capacity-- ----------�----`-'Ty17 pe =w- Ma.eriaC ------->------- No: Compartments ' Distance to nearest: Well-------- -----------.A Foundation--------------------------Prop. Li`ne------------------- LEACHING LINE No. of Lines________Z ------Length of each ling_---+--��0---- -----.Total Length /-. ___s____________ ...................I .�_I X , T r�_ ' 'D' Bax.'- '�{/ . -- Type Filter,Matenal__F ___-pepth4Filter Material._- _ ------------------------------------------------------- Found _______._________________------_-.--.------ --:- -i k -y"t.. f > Distancato nearest: Well f '___Fo ndation__._ �---------- Property Line -_ ________________________ SEEPAGE PI7 Jam'. DepihCI __Diameter N � be� Rock Size___ r'r Rock Filled Yes No Water Table Depth.__._ _ i I .t` -- �1t Foundation ti� Pro- 'Line- ^--------------. Distance�t 1nearest: Well_.__��-;� .:.T,__�._� ;� ._._ �. � -� -,�, Prottine�., , a 11 i - - - REPAIR/ADDITION {P,rev. Sanitation Permit#------ ----- --`------- _�Date--------------_-------------'-_A ------- Septic Tank (Spec ifyjRequlrements)----- ----- -- ! r =. l jj t Disposal Field (Specify.Requirements}; 00 �7� . , # . ( �-- . -------- t - ------------------------------------------------------------------ -- - �. e �� ------------- ------------- "' - -------------=------------------ }. — (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_nvmrk for which this permit is issued, I shall not employ any person in such manner as to ibecome subject to Workman's Conipensation laws of California." . L _tiS-'SSi- Signed--- --- --------Owner _fidEn SERViu_ a 261 itle r T ttu.�, t;.r7� 1 ` {If other t a15 own FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ - -- ---, ._Cly-- DATE - �-- -7)1�---------#--- --- ----------------------------------------------------------- --------- DIVISION OF LAND NUMBER------ -------------------------- - ----------------------- - ------- ---- ;--- ------DATE- ---------------------------•------------- --- ------------ AD�DITIONAL COMMENTS--------------------- ---- ----------------------- ------- --- ------------------- ------------------- ----------. - ---------- ----------------------------------- --------------------------------------------------------------- ----------------- ----------------------------- ----------------------c-.. ----------------------------------- ------------- 3 - -- ---------------------- ----------Date ---------- FinpL_Inspect.ion_.by:r. _ . �- � � _ .-. ..Y....___ - - -- - EK 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76'3M