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r FOR OFFICE USE: FOR-OFFICE USE: APPLICATION FOR SANITATION PERMIT 7_3 Permit No._ -------- -----------------" (Complete in Triplicate) ----------- ------- ------- --- Date Issued._�'l0- _ ______________ This Permit Expires 1 Year From !Date Issued ` Application is hereby made to the San Joaquinit County Health District No. for and existing Rules armit to constructnd Regulations: work herein described. This application is madam Pfia-nce# R Y _ CEN US TRACT-•---------------- ........ JOB ADDRESS/LOCATIONPhon 3 ___________________i__.__ Owner's Name _ ------------------------- ------ --- --:----- --- -------------City t + "' zip Address----- -------- -------- 't ,- Phone ------- .. a ---- -- -License #--=-- -------- ----- --• - ------- ------_- ---- t ��1 _� --- • P o ame_ Installation rsw If serve: Residence;K' Apartment House.[] Commercial ❑ Trailer Court ❑ t etel ❑.,. Other---=-- --------------- --------- =-=-- ----- Garba a Grinder____.---.___Lot.Size_A--=----, Number of.living units:__-r, _ ------Number.of bedrooms_ g ____Private El -- .Silt Clay Pe- -------- Character of soli to a depth of 3 feet: Sand El ❑ YI❑�.,at ❑ Sandy Loam Clay Loam ❑ f Water Supply: Public System an name- _._ _.. ___. p Hardpan ❑ Adobe.❑ FIII Materia 1f yes, type_------------------------------- Ha'r'dpan --- ------ - -- --- - T- ' [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.} [ i ermitted if ublic sewer 's voila le within 20D feet,} NEW INSTALLATION:' "(No'sep'is tank'.or seepage pit p r p ;.._.. . l d - D . Liquid Depth------'oZ. . ------------------- PACKAGE _ PACKAGE TREATMENT ISEPTIC TANK 5ize_. AZ- Ccit). a �Type Material_6JA-C! CA._No. Compa-rtments.__---- --- __--- _-___ ---. f Foundation.-:----- - ------,•------Prop. Line--------------------- e i of Lines_...~ =._ Total Lengfih.. t ,�. .:...Distance�o nearest:-Wel.l___.._-_,- t �.. '., Length of each line. = LEACHING LINE..._ ( l No. " ------- --------------------- D' --------- - D' ox------------Type Filter Materia - Depth Filter Material_ o- -------------- ---------- -_Foundation.___.__ Property Li Distance to nearest:=WellesR led e ❑ No z t • Rock Y s � ❑ Line SEEPAGE PIT � � Depth--- -------- -- Rock Diameter = ers Number.__:. c ' Ro k Size--- ----------=-----'----- ----t =' ` -----=------------ t Water T�ble Depth..+""„,-F-- � � 1 . . ----- Distanceao nearest: Well . - ----- -- Foundation = = ::Prop. Line } V . - r1------ --- ------------------Date--- ------------------------, # } a `. REPAIR/ADDITION (Prev. Sanitation Permit#--------"-. - - - -- --------- --------------- Septic Tank[Specify.Requirements) ---------- --- i ---- . -, - ---- --------------- Disposal Field (Specify Requirements)__--__--'--` --- -- -- -------------------------------------------------- R ---- --- ----- - b - --- --- -- --- - - - [Draw existing and required addfion on reverse side} I hereby certify that 1 have prepared this application s that the work-will be done in- accordance with San Joaquin County Ordinances, State Laws; and Rules and Regulations ffiof the Sari Joaquin Local Health District. Home-owner or licensed agents signature certifies the following: ` f r "1 certify that'in 'the-performance of,the wok for which this permit is issued, 1 shall not employ any person in such manner as I 4 +' to become ject Workm Coritpen`atian laws�;of .California." r Owne Signed F . - -- t - -- - - - ::: (I:f-other than owner) -i� F EP MENT USE ONLY ' t t z ---------- APPLICATION ACCEPTED-BY----------- --------- ----- --------- -------- -- -------DATE.° = - -------- -------- -- -: := .DAT ---------------------____ _ f DIVISION OF LAND,-NUMBER =--- I ADDITIONAL(COMMENTS-------------{---------------- -----•------------------------------i---------- -. ------------------- . --------------- -"^ --- -- ----- - ------ ------ ---- ----------------- ------- ------------- -------------------------------- ------ - y-- -- . to ---------- --------------------------------------------------- •a, --N. ` -" Da _ M Final--Inspection-by " ' F&S 2W7 6 3M EK 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT