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FOR OFFICE USE:. ,a,_ _, FOR OFFICE USE: ----------------------------- - APPLICATION"R SANITATION PERMIT - (Complete in Triplicate) Permit No.77-_73_..- Date Issued This Permit ExpilloYecy From Date Issued Application is hereby mad o the San Joaquin Lo I ea striWf or��a.►►perrr�+,1 to construct and install the work herein described. This application is made ' compliance with au y mance �Vcarrid xisting Rules and Regulations- JOB ADDRESS/LOCAT O __-.-:,. - -------- - - -------- --- ------------------------------------- ------------ CENSUS TRACT ��Owner's Name---- ._ Phone �ddress---"! 3 -- -- :- . Zih - --- - --------... City. - - �CContractor's Name -------=------------ - _-License #----------- ------ --------Phone------- - ----------------------- / Instaliatian will serve: esiden e ❑ Apartment House [Commercial ❑ Trailer Court ❑ Motel,❑_Other;----: _ .:-V _.::--------------------_.-- )(}Number.of living units:_.-------- ---_Number of bedrooms------------Garbage Grinder.-----------Lot Size-------------.---..--....-.--.-_________-------..:--..._-- Water Supply: Public System and name ' -:----'--`---`--`_----- --sT----------------------------------- ------- -------------------------------Private �"��11 Character of soil to a depth of 3 feet:—Sand El—Silt-El -Clay 0--Peat [:j—Sandy-Loam- Clay.Loam- • -. 0 Hardpari ❑ Adobe❑ Fill Material............If yes, type................................ P (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 [ ] ., SEPTiC TANK I } Size---------------- --------------------- �- --------Liquid Depth---------------------- Capacity------ TYPa-----------------------Material---.------ --_---- Na. Compartments--------------------------- e t tciep.... ...,aW --- Foundation-- ----------------------Prop. Line-.----.-:------.-______;.-..est. .LEACHING LINE Noof Lines _Length of each line------------------------------ f Total Length.-----------------------------=--------- , q D' Box-. .....-.!.-Type Filter Materiarl--------------------Depth Filter Material------------------------------------------------------------- Distance to nearest:+Well---------------------- -.---Foundation-------- _--------.----.--.Property Line------------------------- SEEPAGE _____..____..--- -----SEEPAGE PIT [ ] Depth------------ ----Diameter-7------------------Number---.------�---__--------------- Rock Filled Yes ❑ No k Water Table Depth-------------------------------------- ---- -- -- #. --Rock Size------------------------------------------------- 10, -- -------- ---- ---=-------• - --10'� Distance to nearest Well._.__- ---------- -------- 'Foundation--------------- Prop. Line. = REPAIR/ADDITION (Prev, Sanitation P'ermit#_=ya.-J-----------------------------------------Date-..---__-__-____________----.------...____.___} Septic Tank (Specify Requirements)------ fJl --Jf _ _ _______ Disposal Field {Specify Requirements}------ ------ ---------------------------------- --- ----------- --------------------------------------: -------------------------------------- -------- ------- .--- --- ------------------------------------------ ----------- --------------------- ---------------- ----------------- , } (Draw existing and required'6ddition on reverse side) ; I hereby certify that,I have preparbd;this application and that the 4work will be done•in accordance with San Joaquin County Ordinances, State Laws, and Rules.'and,tltegulations-�of the. SaA Joaquin Local Health District, Home owner or licensed agents signature certifies the following:''Y "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 T to become ubject to Wo rkman`s"Cor>npensati aws of California." Signe 4`/'' =� ` _--- - -�--t�Owner �� f Y = ----- 1 ----- -- --- Title ------ ----------------------------------------------- ---- ` } j (If other than owne"). s" FOR DEPARTMENT SE ONLY APPLICATION ACCEPTED BY_ - ---- - - - - "-7:,: _DATE. r DIVISIONOF LAND NUMBER--- ------------------------ ---- v ------------- --------------: ----------- ------------DATE------------------------------- --------------- ADDITIONAL COMMENTS_______________ _ :--- - -------------------------------------------------------=i-- ----------------`-----------..._..- ------------------------------- ------ ------------ ----------....---- - -- Inspection b - ------.Date - --- ----- P Y= �. ------------------------------ 1:H 13 24 �' AN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677.RfA/�7/76 3M