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FOR OFFICE USE: 4 FOR OFFICE USE: ' APPLICATION FOR SANITATION PERMIT d - ------------- -- (Complete in Triplicate) �. Permit No._� -------------------- This Permit Expires 1 Year From Date Issued Date Application is hereby made to the San Joaquin Lo bl'Health District for a permit-to construct and install the work herein described,_) This application is made in compliance with County i-dinance No. 549 and existing Rules and Regulations: 9 JOB ADpRESS/LQCATION - �1---- - I -- - e-- GC�CG�.. Cl - ,�.. ---- - SUS ACT------- . �,w�..._ . lOwner's Name___ i I ` - E :, Phone----- Address [� ��, ,� _ l w k t � �`. .. .-- ; f�' � -Cid - Zip--- ------------------ ;Contractor ----- -l ;Contractor's Nam 1�- ---- -- - r License#�t__ '�t'°fi'�''- -Pone.. e. _� � t ' r I �a .. . < _'. <-r 'r.i- i. 4. t Tlnstallation will serve: ResidenceApartment House.❑ Gomrnercia! ❑ Trailer Court: ❑ } W, Motel 1. i Number of living. units:___ _ __ Number of b room3 _ Gprbage Grinder-_` 'tat`Size :_ -- .'� ' --------------------- ---- --- Water Supply: Public System and name ___ sG.Gs - �, r ---- -- --- ------- ----- ---- -- --- Private �harac#er of soil to a depth of 3 feet: Sand.:Silt"❑ Clay't❑ Peat❑ Sandy Loom ❑ Clay Loam ❑ :Harrii Adobe ❑ � _.� ❑ . Fill Materanl If yes, type --- f'lot,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 orxseepage pit permitted if public sewer is available within 2Q0 feet,) _ PACKAGEuTREATM'ENT—[14 -1----;-SEPTIC`TANK— --�---- /—T� -- - - L Size Lam : ---- ----- uid"Depfh S Capacit 144 ;Type--�iG.G�atwial =_= No. Compartments r y cc tpace,to r�ealest:_V�!elf _- _ 1 Foundation._ Prop. Line �J �.a LEACHING LINE ,�No...of Lines._.____: k..Lero `th of each line.__ _____ f l ` --' J f ---�--. TotalLen th.__. I'D' Box � :, r• ] , __Type Filter Material_ --_De th Filter Material_____ } _.p ' t . Distanearrsst:Well_:- -- 1 oundation'' fa SEEPAGE PIT [ ] iDe th__: Diameter__ Number- } .. s :. p ' er w Rock Filled Yes ❑ No❑ Water-Table De th- --- _Rock"`Siz --------------- --------------------- --------- ,r " ea6e-it:Well-�' - --Foundation--------------------------Prop. Line 1`J -�rt " """ = - --- ----- REPAIR/ADDfTION-.Frau:Sanitation P�- war- I Distance,to n F J S.� I errYT = Dat --- , Septic Tank (Specify.Requirements)--__ ______ - ; 01 1 fi Disposal Field(Specify Requirements)' = ----- { . ?• --- - ------ ----- - --- ------- I (Draw ezistmg and.required addition 8A reverse side] 411" { I hereby certify that I have-prepared this:application and that the work will be done in accordance with San Joaquin County Ordirtances;-Stote-L-aws,- and-.Rules and kRegula?ioRs,,9C_the_San_Joaquin_Local-Heal th,District,_Home_ow_ner or_licenseCagents f . + , signature certifies the Follong: r Y "I certify that in the performance of 4he`work for which this permit'is issued, ) shcili not employ an e p y y person inssuch manner;as. to become subject to Workman's Compensation laws of California."- Signed------ CIOENCE'S SEPTIC & SEWER SERVICE caner 263 So Oro v Stec ktori, Calif 95265 BY J-- TitI6 FF1 916 ;32A --- G0ctit-r-ar's _ zF17 -..._ (If other than .ow r) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEQ Vie " - --- ---------- =- - DATE. --/ 7 - = = x DIVISION OF LAND NUMBER .----------Y_------ ----- : --- DATE-- • + ------------------- ------ --- ------ I- ADDITIONAL = ADDITIONAL COMMENTS-- -------------------- = r ---------------------------------------------------------- - ---------------------I-------------------- --------------- ------------------ ' - ` ll f------ ----------- - ------------------------ ------•-------------•--------- --------- ---------------Fin I Inspection by = Oate-----•---=----- ---------------------- - -----------_--- ___ --------- t ... EH 13 24 F&S 21677 REV. 7/76 3M' V .