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FOR OFFICE USE: AN FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT i- Permit`No..771/CS/(J ---------------------- (Complete in Triplicate) -- ---------------- - bate Issued-l�--�5-"-�7 _------------------------------------- This Permit Expires I Year From 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: f JOB ADDRESS/LOCATION_-- / 1.,�, 7634-i'�"I lel- 4 `•-5U5 TRACT / Owner's Name /�/� -----Phone.-?z�.� - �A City.r.��la•4i1�"�- z i P 3 Address._._ _D4.� `� "``----------- - ------ Contractor's Name----------------------------------- License .# = Phone Installation will serve: Residences Apartment House❑ Commercial ❑ Trailer Court ❑ 4 '� Motel ❑ Other--------------------- -------- ----------- -- i ' ___-__Number of bedrooms._ g -- Number of living units:----./ _Garbo Garbage Size_-_____ ? _-- .................. Water Supply: Public System,, name------------------ - ---`---- u Private Character of soil to a depth of 3 feet: Sande Silt[] Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Harclan�❑ Adobe ❑ Fill Material--..__-__--_If yes, type___ __________�__-------____. {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be' la on reverse side.) ' "'(No' septic tank or seepage pit permitted if publicseyver is ava)lable within 200 feet,) Size__ `*- '-i,_J---- q P PACKAGE TREATMENT [(No SEPTIC TANK [ ] ---- ----�'--� -�-- � o I o': Compartments-_____- -----0 - sj _=._TYPe Materia ------ Capacity-P400I< Distance to nearest: Well------ ��----------- -----Foundation------ t f Prop. Line.----- ------- -t ' e_�__-----_-_ ,.Total Len f - --------- - No. of Lines----------- Length f each line.---- --- -- gth f--- Q------------------- LEACHING LINE D' Box.... --...Type Filter Materiall-�--.121 A.Depth Filter M terial-------------�� -------------------- ----------- / ® --------= Distance:to nearest: Well------ @------- ---Foundation---------------------- ---Property Line.------ ---- ©- - SEEPAGE.PIT [ ] Depth_---_---___,__-Diameter---------------______Number--------------------------------. Rock Filled Yes ❑ No ❑ ' Water Table Depth-- =---------------------------- --------------------------Rock Size------------------------------------------------ IProp.y Distance to nearest: Well- -.------- i--------------- ---- -------Foundation-_ = Prop. Line i REPAIR/ADDITION (Prev. Sanitation Permit#- ---[- `"-_ _. t -----.Date--------------------------------- ) 1 ---- -------------------------- -------- - ------ } Septic Tank (Spe�ify 'Requirements)-== ---- =- ----- -=---`��--------- ------� - -�^'------- ----------------- ----------- k 4 [ ------- t DisposakField (Specify Requirements) ------_- - ----------------- --------t --'------------------ ---------- - ---` t-------- ----------------------------------- ---�-_,------•�------ `: '% a - /' I ------------ ------ i I hereby certify that I have prepared this existing and }equired!addition on reverse side) ' his-a lication-and that the work will be done in accordance with San Joaquin County Y P P -application Ordinances, Stale Laws, and Rules 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,.tWs permitisissued,'I shall not employ any person in such manner as to becom subject t W r n .CompeA ation lawsCof Califon hia." I Signed' - ---- ------ -------------- Owner [ $Y-' ------ ------ --------------- - --- --- ;- -------------------------- -- it ------- , s ` t T' le. (If other tha wrier) .. fQR.DEPARTMENT USE ONLY ¢" } APPLICATION ACCEPTED BY =_�: ----- ------------------------ DATE. T { 7------------ DIVISION OF LAND NUMBER._--------------------------------------------- `-,: - ,------ DATE__:- = i ADDITIONAL COMMENTS--------------------- _ - --------------- - 1. . ------ ------ ----------- ------------ -------------- - ----�.� --� --------- Final ,° Date ns,..ection b --------- ---------------------- ----------- -- --- Fos 21677' EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT 'a sM