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FOR OFFICE USE. FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------- -------------------------- --- � 36 ---------------- (Complete in Triplicate) Permit No.,7.e --------------------------------------------------------- Q`?/.q - ---•--------------- ------------------------.--.-- This Permit Expires 1 Year From Date Issued Date Issued_/-/- Application is hereby made to the San Joaquin Local.Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION__,.:._-_..'__ __ ' -CENSUS TRACT__:_________ SK Owner's Name. 4 -l- 1 ,( 1f1� J.-----------: - :.--------:------------_-- - : _ __- .:_ _ -- -----Phone - . - ._ r Address -- - ---------------------------------- -City "�1 Zip--./77 J Contractor's Name--------- � .------------- ---------------------License #-p� rPhone--g-6 u -- 'rvr-LL nonrvuvrvMrN I u OTHER LE PUMP INSTALLATION LJ PUMP REPAIR❑ REPLACEMENTQ DISTANCE TO NEAREST: Septic Tank', Sewer Liries Number,of living units:---I-- --__Number of bed rooms:.-.__Garbage Grinder__=---------Lot'Size__. _ _ _ _------------_------- 7 Water SuPP_ Pblic System and name_ :_ ' - -- -- --- ----- pryvate , Character of soil to a depth of 3 feet: Sand ❑ Silt(] Clay 0� Peat`❑ Sandy Loam I Clay Loam ( [ . - 3 Hardpan ❑ Adobe ❑ Fill Material_._5.� If,yes;¢type__._._____'_______-------------- t I {Plot plan, showing size of lot, location.of'sysfem�in relation to wells, buildings, etc, must be placed on reverse side.] , NEW INSTALLATION: (No septic tank-or seeppge pit permitted ifypublj�c_sewer,.is,a.vailab le wi!in 200 feat,) l GE TREATMENT [ ] I SEPTIC TANK � � (� PAC KA 5ize.> --- I ----------------- --------- Liquid Depth.----------- -1 A Ca acct T _ -- _ d,' G t ` � Mater�l_��.s-=--- -- - [- --Nl4:fCompartmerits ---------------------------------- Distance j ---------------------- :Foundat obi-_-",---- ------` Prop. Line. 4 r -1,1, _ {O LEACHING LINE [ ] _ NorofcLinesneares--. a Length,ofeach line.-'--------- ---- `_ _ ____Total Length.___---- --_--_._--___.___.__ . D' Box_ ____ �_T a Filter Material _. _____,._-.-__Depth Filter Materi4l________________ -Type - Distance to nearest: Well-,.---- _ -es-.Found`ation _-- Property L ne--------------- -- PITT Depth------------- Riameter__..___ [ 1 Dep4Numb---------------------------------- SEEPAGERock Filled ' Yes ❑ No ❑ Water Table ] g / e h = --- _ _-.Rock Siz Distance to nearest: Well :. _f_._ Foundation`s ____. _. Prop, Line---------------------------- ----------- / t -I � * REPAIR/ADdITION (Prev. Sanitation Permit# r.�_ ____._. . _.___ ��.___ Date��--------------__ _ _______ Septic Tank (Specify Requirements)---------------- -- -----------------------------------------------:_-- ------- ------ ---------------------- Disposal Filld {Specify Requirements)..._..4_�14,(�A�__A01A (l� ----- _....._,/&-� 1 __-_-_.--- ----- ---------- ------ _. 4 ------------__------------ - - _ _-- -------- ----_ ,, ___-___-, _----- --.y_. - _ _ __________________r_____-_____________'__.-_.--_ _ _ . ! __ _ _____ _______ i ! ----- ------ ----________________________ _______________________________________ ________ __'_ ___-___. ____ - _. ______F '! __ __ ______________________________________________________..___.-_____-.---_____--.. .,..yf '_.n- [Draw eicisfing:and'equirec] abdifion on reverse side} I hereby certify that 1 have-prepared this application and thatilthe work�s—will-15 done in accordance with San Joaquin County Ordinances) State Laws, and Rules -and Regulations lof the` San Jocagwn Local tHealth District. Home owner or:licensed agents signature c�rtifies the following: t "I certify that in the-perforrncsnce of'the work"for which tFiis permit is.issued;1 shall not employ any person in such'manner'as to become subject War man's ompensation� laws of California.'.' .I Signed_- - �..� Owner 0. BY = ` a` r_Title ----- [If'other than'owner] e f s FORS DEPARTME T USE ONLY"" " ' R APPLICATION ACCEPTED BY-..._- ` f = ----------------------- DATE /..- h DIVISION OF LAND NUMBER----- = - :• -- ---------- D ADDITIONAL COMMENTS ------------------ ____ - -_ -------------------------------------------------------- t ---k ------------ -- -- ------- --- '.0 __ .. •` 5 `' l # _ - a , . ------------------- ------------- --------------------------------------------- ---------------------------------------------- -- --------- ----------------------------------------------------------------------------------------------- "' Final Inspection by: = -------- - ---- - - - - :Date- '2 ----------------- EH = -e" 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT gas 21677 xev.7/76 am 3