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FOR OFFICE USt_:i FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT p Permit No. /-�� - --------------•----�-- ---�� - . - (Complete in Triplicateh 5. �,) � 3 Date Issued.-_)R1_-` 7/ This Permit Expires 1.Year From Date Issued. Application is hereby made to.the San Joaquin Local HedantancEsNo'�549 a permittrict for a existing Rultes and Regulations:ruct and install the work herein described. This application is made in compliance with County O �� ///jE ... �rc/5. - CENSUS TRACT-------------------------- ---- I J08 ADDRESS/LOCATION .. ............... ... - ----....::.......:. ....................-- ._........ .. 3 31 . .. ...... Owner's Name------- . .- - t3- �-�s Address--.. ....��`.rl - --..- -.Ci �Y13 c --------- ----------- --Zip Asa..---. ... --- Cit -- --�-�� . -•-- ...... :.. .... License Phone... . . - - Contractors Name.... .. - I - - Installation will serve: Residence � Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other.-. -------- ..----- Number of living units:....-..�:.•.---Number of bedrooms... .--. Garbage Grinder---.--------Lot Size-- - w private Water Supply: Public System and.name+_._._...... - �=- - - - -- - - 1 Character of soil to a depth of 3 feet: .Sand ❑ Silt❑ Clay ❑ -`Peet ❑ Sandy Loam 0 Clay Loam [,J Fill Material . ._.. ---------------- ---- Hardpan ❑ Adobe ❑ If yes, type - ... ' (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) ; NEW INSTALLATION: (No seetJ eptic tank or seepage pit permitted if public sewer is available with'�12d�fDe th. } �—� qp ............. PACKAGE TREATMENT { } SEPTIC TANK [ } Size------------------------------ -- ------ + 1 BOO Type-- (.jsT -' No. Compartments...... _ Material.. Capacity- �- --- YP o' -Foundation...-- Prop. Line..-. _.� ..... t Distance to nearest: Well.:..-..... ..-_.- -- - ----- - No, of Lines --- - ------.Length-of each line----------- ------------- ----Total yLength .......-........._:.. . ... LEACHING LINE [ } 'D' Box- ../ :Type Filter Materia�l_eR-r f`-. ---.Depih Filter Material_---.- �— 'Property Line..-- ......... Distance to nearest: Well-----_-^'��----- Foundation-....-.- p Rik Filled Yes E] No ❑ SEEPAGE PIT } } Depth -.-Diameter................ ...Number---------------- t - 1 Rock Size__ ------------ ------ Water Table Depth----- ------- --•---- ----- --- ---- w, T -- ------Foundation --..- -. .Prop. Line ------- Distance to nearest: Well--------------- ----- - - f r ...... ---------Date.... .................. ---------- REPAIR/ADDITION (Prev. Sanitation Permit#----- --- --= �. . . ; ..._... _v-.��- ,- --------- ------ ---- Septic Tank (Specify Requirements).... .!__- -------------•--------------- -- ---- .,..... - ' Disposal Field (Specify Requirements) --•---= ---- --•-- ------------_--- ---- .. ..-- - --------------- .--- .-- --.. .L - (Draw existing and rec�u:ired addition,.on reverse side) ance with County I hereby certify that I have prepared this application and that the workwill be dHealth District. ne in dHome owned Joaquin or li esed agets Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local signature certifies the following: person in such manner as [ "I certify that in the performance of the work for which this permit is issued, I shall not employ any to become subject to Workman's Compensation laws of California." ,r SptV ........ -..-.--Owner Signed....--- ±ry'_---- ....... .----- .. --- -------=--- -- - -Title..... - ---. . .. - (I er than owner) ` F FOR DEPARTNaE T USE ONLY i DATr E ... APPLICATION ACCEPTED BY-- . ........- DA DIVISION OF LAND NUMBER ----- :'� . ------- --•--------------------- .-........... ADDITIONAL COMMENTS ... 1 -------------------- -•------ ..-•--- ------ ----------•--- - ..._.._ ---------- - i -- .----------------------------- ................. ------ ---- - ---..... ------------ . _ Da �' r _ Final Inspection b -'- .--- .. - F&S 41677 REV, 7/76 EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT