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�� ------ FOR OFFICE USE: FOR OFFICE USE: P1 APPLICATION FOR SANITATION PERMIT ---------------------------- -------------- [Complete in Triplicate] Permit No.7ens,4._ s . f --------------------------------- ------------------- - Date lssued_/0-6_:�_ _ ------------�-; ------------------ - This Permit Expires 1 Year From Date Issued Application is hereby-rnade to the San-Jopqu=in Local Health Distrid for a permit to construct and install the work herein described. This application is merle in compliance with County OrdinanderNo.,549 and'-eitasting Rules and Regulations: r f��G� !' ----- ----_. T ACT--- JOB ADDRESS/LOCATION-._ �Q/..- �_ 1 Il__ " Owner s Name- ------ -- - l �` --- ------- `itY Address__ - _ �.� � Jr "_`§ • i 760-7------ 7 ,I Contractor's Name--- ------------------ --= = License #.a ` '_3 .---- Phone__1-U Installation,will:serve: Residence ❑' Apartment House LJCommercial Traaler`Court° ` Motel ❑ Other ---- Numberunits: • � i of living,units:- _.- -.--Number of.bedrooms --__ ---Garbage Grinder--- ---__'_Lot `-- i -------- ----Private `� Water Supply: Public System and'name---- :._.-- .--- :._: _ _ I r Character of soil to a depth of 3 feet: Sand [] 'Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ rClay Loam ❑ Hardpan ❑ Adobe tK Fill Material.-._-'•___-.If yes, type__------------------ --- k - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) , P. , NEW INSTALLAT{ONc""•�"'.'.(No.se tic tank `or seepage pit permitted if public seggwe�• is available within 200 eet, ��/{ i ... .i Si - /-�1-�----�------------------ SEPTIC Liquid Depth._ ----------- P - PACKAGE TREATMENT [ .� ' TANK - j `--- • T e____�--_Material_� C'2.1G _-----No. Compartments_----_�-:----- t �r• Capacity_- +/ ------ YP r, .... Distance to nearest:.Well.: ------ ------- =....... --- Founda#ion------`© _ Prop. Line LEACHING LINE; . No. of Lines. _- --- - . 9 ::Total Len th.,_..__lG --------------------- -'-- - � ;-____.__ Len th of each line g l:..... ,,. t.e.rial-.::-._._.....,.fr.----,--� - -----n--e_-_-_-D' Box.-_- ype FilterMat ial-_/ c Depth Filter Ma _____.- { ( 'Distance_to_nearest:.W. 60" :_.__.Foundation.__ _1 =4--------- --- -�-�.Property ro ertY rL.i uDepth - -.Dmber �_ -- Roc k T Filled SEEPAGE PIT - Yes N -.Rock __ .- [ Water Table Depth.---------- ---'-- ---;- - ---- ,---:-- -- -,- - --� ----- ---- ---•--� � f r f. .. [ Distance to nearest: Well:_--- --7--C-�----------------- -- P. ---�--- -Foundation- --- -- 4 Pro Line- --------------- ?. REPAIR/ADDITION (Prev, Sanitation Permit#--------------------------------------- -Date--:-----------------------:..--- 1 f Septic Tank [Specify Requirements]__-°_---- -------------------- �-------= -------------- - ----.- -- --_--,---------------------------------------------- Disposal --------------------- ------------------ Disposal Field{Specify Requirements}�------:-�-------------------- --------------------------------- -------------------------------- '------------------------- --------- -------- , A - -------------------=------------ -------------- ----- ----------------------- -- - {Draw existing and required addition.on reverse side)' t ' I herebycertify that;l have prepared this application and ;that the work will be done in accordance with San Joaquin County Ordinances, State Laws; and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents signature certifies the following: M f : , "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 to become subject to Workman's .Compensation' laws of California." I Signed- A - Owner �p ------------- ---- ----- , Title r-----�--- BY-------- ----- - ---- t other thdn.owner) "FO DEPAR ENT US ONLY APPLICATION ACCEPTED' BY- _ `= rte _ = '------== DA - --------------- ------------------ , c / --- TE ! - 7 ' DIVISION OF LAND NUMBER --------------- - ------------ = =--------- ----------- ------ ------- ------ DATE ADDITIONAL COMMENTS------------ ---=-- o [ = �{� -------------:--------- ---- ---------- tl -18 -------- - --------- -------------------------------------------- ---- --- ------- -----------.------------------------: _ a - -------------- Final Inspection b . -_�._ .�.�. _ = Date. - �- P Y''" - F&s 21677 REV. 7/76 3M EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT t