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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANIT*TION PERMIT --------------------------- (Complete in Triplicate) Permit No.7F_ ...___ --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date issued__$—F'.7_�r_ Application is hereby'made to the San Joaquin Local Health Distri&for a permit to construct and install the work herein described. This application is made in complience'with County Ordinance No.�54_ftand existing Rules and Regulations: # JOB ADDRESS/LOC ON. - - - 1�./---tL-^:Q.[ -- -t 'r/�_. ?. :---.CENSUS TRACT---------- - - �y-- - Owner's Name . ---� / ._.. K. 1 -- -------- Phon /[Jy �2 Address------------5 = = �-d `-.' `—T= _ 'tY -..J..�..'F �C f Contractor's Name---- / r. i RAS ----------------------------------------License #. / hone --- �a --- - ---.__. ;. ... �- ' .� Dote) `Other ------= -�--=--------"---..---� �❑ �Court El ..4 Installation will serve: Residence Apartment House Commercial Trailer C Number of living units:__:/___..Number of.bedrooms�---Garbage.Grinder---.__.._._Lotr Size. _� �r,.- --------------------- ---- ___._____.._.__- Water Supply:..Public System and name-; - ----- .-..:_.. -------------------------------- --L------ ----------------------------Private ❑ Character of soil to a depth of 3 feet: : Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loom ,Cl y'Loam ❑ .. .... _,. _ _� _, _. _ _— T ....t...,�._a. �._w ,.._ kms....-.:. -. Hardpan ❑ ' Adobe Q Fill Material_.._.= If yes., type_?_ ____° •'t i (Plot plan, showing size of lot, location of.system in relation to wells, bfuildings;.etc. must be placed on reverse side.[ W NEW INSTALLATION: ![No septic tpnk or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT' [ ] SEPTIC TANK Size_//�� CTcL._!__.___ -Liquid Depfih_____________________.___ Capacity--------- Type-=-----' fi__Material ---- V_ -----------No. Compi rtments--=----- =----------------------- Distancejto nearest: Well_,__..__-:..._.---. .____�.___oundation__________________ __Prop. Line_.=- F CS,i LEACHING LINE, [.] No. of Lines_: „:-------------,Length_of.each_line- _ 1,Length ______ D' Box._�..Type Filter Material_ _ Depth Filter terial_ -( ------ __ _____ _ * Distance to negrest: Well.,.________ ____________Foundatio ___________.______.___.__:Property Line------------------------------------ Rock _ -_-___._` ._____________ PIT j ] Depth-a-- -.---Diametef --------- SEEPAGENumbers ___ ------ --- R F I ft x _ :Y�� Noy❑ _ ock ,il ed Water Table Depth h------ `--------------- --------------------Rock Size,------- f ---------J---------�-------- �i Distance to nearest: Wefl__ --..�61 _ -----------------------Foundation._�a�____ ----------- Pro jLine:�_ pi _ = REPAIR ADD / —ITION (Prev.(PreySanitation ermm�it# Date - .j Septic Tank-(Specify Require ents)___ ______ _ __________`._:_ - --- ------ ---------------------------------------------------------- -------------------------------------------------- -'t .� Disposal Fi Id [specify Req ireme edits) - -- -- - -------------------------------------------------------------- -----------------`--=r` =---------- - -- - -. "-- -----------=----------- -'-- ------ --- ------------ - ------------- ----- .--------' ------- - - - - ----- i - i -----=-------------- --------- ------------------ -------------- •-------------- -- - _ ~ ¢brow existing and required addition on reverse side) 4 I hereby-c fythat l have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances;-:State Laws, and es and Regulations_ of the San Joaquin Local Health District. Home owner or licensed agents signature•certifies the following: : ' "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/Wor n's Compensation, laws r of California." r Signedl .._- ------ -------- _Owner -----.-r_Title-------- - �. 1 .a_oth6r._tkan_8w" ner) t FOR'DEPARTMENT"US —454LY APPLICATION ACCEPTED p - ---�-------------�--------------------'''----------- ----�------------------DATE.. -------------- DIVISIONOF LAND NUMBER -------------- '---'- --- ---- -- ---------:----------------------- -•------ -----------------------------.DATE-------------------- ADDITIONAL COMMENTS------------------------- ----- ------ ---- -=-------------------------- .. - 1 __________________________________________________________ _ ___..___.__________-.-.._-.___..__.__--_._._________.____________________________._______.____.____.___._ _______.____ ---------_---------------------- ----------------------------------------------- ________ _____ ____________._______._________________.___._________________-____.______.___________.__.____.________._ ----------------- _________._._ Final.Inspection�b _ _ - - - ---Date-------._ EH 13 24 SAN JOAQUIN LOCAL HEACTH'DISTRICT F&s 21677 REV. »>e 3M