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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------- Permit No.--- .7~ 75 (Complete in Triplicate) -------------------------------------------- --- - //_ - 77 ---- Date Issued.-------�-------- -----------------------------_--- --------------------- This Permit Expires 1 Year From Date Issued F App1 ication is hereby made to the San Joaquin Local Wealth District for a permit to construct and install the work herein described. This 3pplication is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION------------------ !_----- - �'¢- - ---_----.a-CENSUS TRACT--------------------1---------- � _ s Owner's Name- ��1/�-----��,P�h- i�C?-------- --- :. :. ------------- ------Phone----- . --r Address--------- h -Li city-- -A i�lt&.Z �✓�- Zip ' Contractor's Name------ 1. f_fr � �. _ - --=--Phone `f' ... ........ Installation will serve: Residence Apartment-blouse E] Commercial ❑ Trailer Court ❑ Motel ❑ . Other-------------- --------- Number of living units----- ----------Number of.bedrooms_ .T--.--Garbage Grinclor------.--. _Lot Size---- �- -----_ -- ------------- 3 i Water Supply: Public System and name---------------- -'- ----- ------------------.-- -- Private Character of soil to a depth of 3 feet: ' Sand ❑ Silt ❑ Clay ❑ Peat❑ Sandy Loam%- Clay Loam Hardpan ❑ Adobe ❑ Fill Material--.-.'------If yes, type------------------------------- (Plot -(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 f ] ,SEPTIC TANK [ ] Size-----------------------------------------------------------Liquid Depth--------------------------- capacity -------------------------� t•+ Ca acit ---------------T a ----------- ----- Material--------------------------No. Compartments------ ------------------- Distance to-nearest: Well � � i ------- ------ ----- _------- -----Foundation----. ------.----Prop. Line--------=-------------__--- LEACHING LINE; ( ] N'a:,,of Lines----- - - ----------------Length.of each line-------------------- ------.Total Length.-------------------------.-.--.-------- E 'D' Box------------Type Filter Material;-------------------Depth Filter Material--- ------------------------------- i SEEPAGE PIT Destth ce nearest:iometer-4 l -.-.- -_-.Number-ndation-=-=-------------------------ProperRock Filled Yes ❑ No E10'7 , r .------ ----- ------------ Water Tabiekbepth--- ------------------ ------ ------Foundation' .Rock Size to nearest: Well ------ - Foundation-----------------'--------.Prop. Line -------------------------- .�. REPAIR/ADDITION {Prev. Sanitation Per mi ...........=---------------------------------Date------------------------------------------------]� Septic Tank (Specify Requirements)._,___ ,---- ---------------------------------------------------------r------ ------ ---- ---- --------- Di ` i ---------'- .-2_fRit ]_ � . .� -- - -----�------- ------'{----------------- `. ------------------------------ .. t { i ------------=---- --------- ------------------------------- -_ "°----==------- ------- -- ----------------- -- i JDraw existing and required addition on revers-side) r I hereby certify that,l have prepared this application and that the work willbe_.done in accordance with San Joaquin County i Ordinances, State Laws, and Rules and, Regulations of the;.Son a 4-uiW Local Heal tfrilistrict' Home owner or licensed agents -- signature certifies the following: "I certify that in the performance,of the following- work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to orkman's Com-pensation, laws-of-Calif ornia."Si 7.g :Owner �' • y. 1. By----=---------- ---------------------------------'---=------------;'-------------- Title-=: - f + (if other than owner] J�-~��'��; � �. � I ( f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY :f ------------------=----------- *�_ = DATE. Z -_ t y ' DIVISION OF LAND NUMBER.-------:--- ------------------------------.--------------- {i__.DATE. ------------- ----- -------------- - - ADDITIONAL COMMENTS------------ '`----------- -------- ------------------�------�------------------------------------------- - -----�-- ----------------------- ------ ---- .. _ . _ _ .. �---- ----- ------------------------- n_ �f . ... t ------------------------------------------- ----------- l-*------------ Y ,, {'----------------- � ---------- Fin61 Inspection-by: Date------`.--- -- --- -- * EH 13 24 SAN JOAQUIN LOCAL WEALTH DISTRICT F&s 21677 REV. 7i ti F