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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT = Permit No---7-7�./r7-- --------- --------- - I` (Complete in Triplicate) -_•-- ----- - - -II�--- Date Issued./�'�� _-________.__ This Permit Expires 'I Year From Date Issued ----- ,i. IF , ., Application is hereby made to.'�the Sa�'�Joaquin Local H alth` DistricY`fo�'d`perrriitft'o-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_..,, �, '� •$------ 'y-_/r). ------ `{ -----,°-•--- ------.CENSUS TRACT I --- one-- - --------------------- 's ----- . --- 'I 83�'`G Owner's Name.. - --- �7J -h--� Y-E f 5o/- -- -- --- --- -- s� �e Ir ��44 .,_—City T'-riv G;�_ Zip Address_.. -- . = _� _ saki ::� ,j .�o.v i License #--,:X- 's _-Phone-.S"'Z - f ContractorName-:- installation will serve: Residence 0 Apartment House ❑ ommor �❑ Trailer Court Q 1 Motel ❑ Owe ------ -.1' C, 1 j--- --- --- V ' Number of loving units:-_.4_. �-',___._.Number df. bedrooms___YGarba.ge..Grinde�r-1_- -Lot Size------ %� - - ----- ilpp. i Private Water Supply: Public System and name--_..{------------- _---. r 0I i Character of soil to a depth f, 3feet, Adab Sand SfFilllt ❑Mat real------------elf yat �, type Loam Clay Loam ❑ ❑ ---------- -- I Hard r �iIN P ❑ . f � � ' (Plot plan, showing "size of lot, location of-system in relation forwells, buildings, etc.must be,placed on reverse side.) NEW IN ''-(No septic tank or seepage pit permitted if public sewer is available within 200 feet,) i <k PACKAGE TREATMENT [ ] SEPTIC TANK [i] Liquid Depth-.________________- �� Sizer---=-----� ----�--- ----------,-._--=-------- - Ca acit I '004AI._T e: `G CAST_Material_:_Gd�<c _ No. Compdrtments--=-- ---------------------- -------------- --------------------- Ip Y------ -------=------ YP t , , �I oc �- 1 E -------= Distance to nearest: Well ------ ------ ---------E------Foundation,-- -�-_-- Prop: Line__l -- -. i l' - _ - :¢ . � --------------------------------------- LEACHING ---_��.a . --- - LEACHING LINE Nof Lines------- of.each line------ ' :------ Total Ln 'D' Box._._ . Type Filter Material p Filter Material-----------------------.___ --- -- ----- --- - YP t ti s- I , /cn 1 Depth - Distance to nearest: ell_=--__-�'_n_.-- --Foundation__ '__ ------` ------- .Property Line. -----.------------------------ W Depth.------ Diameter ---:.-_ Number -- p � Rock Filled Yes❑ No SEEPAGE PIT [ ] Water Table Depth-- - -------------- --------------Rack Size---- Distance to nearest: Well------------------------ Fouindation-------------------------Prop. Line---------------;----- i, � j REPAIR/ADDITION (Prev. Sanitation Permit#-------- ------- ----------------' Date-------------.-=--;--------------- = 1 LL Septic Tank (Specify Require Iments)---- ------ ------------- -=--=--- -- ----------=-=- ------ i� ; Dist osal Field (SpecifyRequirements)-----------------__ s - ----------- - f - -- ----------------------------- ---- ---- - ----- - --- ----------------------------------- -- "--------- - --------------------- ----------- -------------- ---------------------- ---------- = (Draw existing and required addition on reverse side)' a I hereby certify that I have prepared chis application and that the-work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of thelan Joaquin Local Health District. Home owner or licensed agents signature certifies the following: t ,I�. . "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 Compensati=on laws of California." 0. Soli __Owner Signed _ _-____ . --------------------------- Ti e � '- o'ther.fhon''owner) ;;_ Jr 'FOR DEPAR ENT USE ONLY ' APPLICATION ACCEPTED BiY._------ ------- - -- --- ----------DATE 7� DIVISION OF LAND NUMBER.-------------------- ------ -------- '-------- ---------------- -- ------------- ------ DATE ------.----------------------- -- .... .� r ADDIT AL COMMENTS-II --------- -------------------------=--- ------------------------------------------------------------------- el --------- ------------ --- --------------------. _.:-------------- ---------------------------------------- --------- .------ ----- ---- --- - - - Final Inspection by: ----- EH is 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/7h 3M I � ,