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FOR OFFICE USE: <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <br />This Permit Expires 1 Year From Date Issued <br />FOR OFFICE USE: <br />Permit No.79,F..9A- <br />Date lssued./4�!-/ <br />Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br />This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br />JOB ADDREWLOCATION ------- zVew.,7:11. . ._._,_CEtLS.US_jRACT ------ ......... <br />4; ----- i---- ................ <br />Owner's Name. . ....... <br />.............. .....Phone.- <br />---------- <br />4)k <br />Address----- ----• ....................... -------------------- CityV <br />Z i P7r/i3< <br />Contractor's Name ....... ............... ?1 ---------------- License #.---.-__-• ...----..•...... Phone.—_1,w.........._. <br />Installation ,will ,'- serve: ResidenceApartment House F] Commercial E] Trailer Court'[] <br />Votel-E] ­ Othetr ................... ............... <br />m Size____ ---- ------- <br />NuMber of living units:, --- ...---Nu ber of bedrooms. _Z_A;arbage r7i or .. 4 <br />% I <br />Walter Supply: Public System and'name ...................... ................ <br />.............................. ........................... ---- --------------Private <br />Character of soil'. to a depth of 3 feet: I Sand E) Silt E] Clay ❑ Peat [I Sandy Loom J4 Clay LOOM Lij <br />Ha-rdpan E] i Ad'obe.o*yes, type ----------------- t .............. <br />(Plot plan, showing size of lot, location of- sysfem in relation toel 'wells, buildings, etc. must be placed on revers side.) <br />1 - 1, 1 <br />NEW "INSTALLATION:"' (N6"ibiatic' tarik'"or seepo'ge' pit permitted if public sewer is available within 200 feet,) <br />PACKAGE TREATMENT SEPTIC TANK I Size ........... : .................................... _....Liquid Depth.t ....... ------------­-- <br />P <br />-COpqcitv ...... Material ....... No. Compartments..4.......--•-- ............. <br />-.7 -Type ------------ ................... <br />Distance to nearest: Well ....................... ........ <br />....... Prop. Line--. ..................... <br />LEACHING.LINE No. of Lined ........................... Length of each Ii6a .................. total Length.. <br />............... <br />'D' Box ------------ Type Filter Material ------- .............:.....Depth Filter Material --- ........................... ---------- - <br />------------- <br />e <br />Distance to nearest _N ------- Foundation...:-____ ►............. !.--.Property Line.. ............ ........_.__..... <br />SEEPAGE PIT Depth ---- .......... '.Diameter-, ------ ........... Number --_--------------- .... Rock Fifted . Yes E] No E] <br />Water 'fd' b1,J%,'b.epth ........................... \-- <br />.----------- ............ S....Rock ize.,____. ............. ------ * ....... ............ <br />I * Ifine._......'_.._.._:......+ I <br />Distance'tb re'st'/Well..................... ........... Foundafion ................ .... <br />REPAIR/ADDITION (Prev-Sanitation P.4614 -_-------------- 'E ... ......... V1 ---------- Date...J; ------------ ....... <br />........... k - ........ <br />Septic Tank (Specify Requirert�ent rY 1. 1 � w.% <br />------ ----- 1149% -------------- ------ .......... ------ ..................... <br />-­-­------- ........................... <br />!771 <br />Disposal Field (Specify Rb mtsil- <br />IL Ir,,,: <br />..................... ............. --- ----------- ........................... <br />................................................................... <br />. ............. <br />­__.: ........ ..... .................. .................... .. .............. <br />......................... j <br />----------------------- ------ -- ----------------- <br />pra existing ona7equire addition on reverse side) <br />I hereby c :1 h P rec �,; .1 h . is up and that the ork will . clL 1 7 <br />certify of be ne in accordance -with San Joaquin County <br />have prel: plication a <br />colons of the (Sari Joaquin Local <br />Ordinances, State Laws, and Rules' Wealth District. Home owner or licensed agents <br />signofure certifies the following: <br />"I certify that in the pi4brmanci6'of'fh4 �WoA fol which" this erniit'is Issued, I shall not employ any perioj in:iuch manner as <br />to become sub ect to.. <br />)N�®rkElan' C <br />iln laws of California." <br />Sigi <br />o <br />0 <br />ied.,... r . <br />. ....... . .......... <br />W <br />.............. ............. -------•- ... Title ---------- ........................... . ......... . ............ <br />By.! .......... -------- 1 ............. <br />(If other th.an!owne'o <br />FOR 15ilikRTMENT USE ONLY. <br />APPLICATION <br />DIVISION OF <br />A-DDITI'CKA' <br />ZEOTED: BY -1:... <br />n N1 lAA RFD' <br />........................ <br />----------------------------- <br />................. ................ <br />Final Inspection by:.. <br />EH 13 24 <br />................. ............. ......................... <br />............... DATE ........ <br />................. DATE_ ...... ....................... <br />........................ ....---------•------------------------------------- <br />.. ------------------------------------------------- ....................................................... <br />-------------- ­ .......... : ................................................. <br />. r�� ---------------------------------- I ............. I ........ - <br />............. .................. �L _. N 7, ........ ..................... : ......................................... .. ............ <br />..J. * — N ------------- <br />--------------------­--­--- ------•----------------- <br />I --- ------ <br />I?r, ....................... <br />....... . . . .................................................. Date --------- <br />N JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3! <br />