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FOR OFFICE USE: FOR OFFICE USE: ] APPLICATION FOR SANITATION PERMIT. Permit No._ ------------------------------------------- --------- (Complete in Triplicate] --------- --- ---' -'-----'-' -- Date Issued-4�7c�.'7-��.. This Permit Expires 1 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 Ordindnce No:•I49 and ekisling RUIes.and Regulations: Y --------- --------------- ------ = CENSUS TRACT----- --------- --------------- JOB ADDRESS/LOCATION. _III 7.33... �`--- ----------------- ---- ',1' d` r Phone Owner's Name._ DC�_ � ---�'��^-'------� --"----=� , _=�-----------_� -- �.., - : �- ----- -. Name. ---=-- Address------------------ ------------- ..City " ��p 1 NJ+��-s.- . a1 s-- � Lam ` 7 - ��} C� 3 _ Phone__ � �----30-7-----' Contractor's Name --`-.-'.-- . ----- _--- .-License #-----.. -- --�------ - �- "'-- Installation will serve'. Residence In Apartment House ❑ Commercial ❑ Trailer Court ❑ 4:. , Motel ❑ Other-=-'- ------ ------" - ; ` � t l x g �> Number of living units:..'-._._.- __--Number of bedrooms.-- :Garbo a Giindsr v -----Lot Size) .. � -------- � <, - t' Private [K 1 Water Supply: Public System and nt�me`W` '-..- ---- -- - F �y� +fir - Character of soil to a de t of 3 f t; Sand ❑—Silt• .,—CAay,LH Pea;[ Sandy Loam Clay Loam 0 p.�• cry f gj"rte �S 4 �+ E�ardpa1❑ : Adobe'❑ ;,Fill'Ma eridl_ r!�_.If yet, type- �--- -- ------------ n ' (Plot plan, showing size�f lot°, locartiia of system in relation to wellsbu�ldings, etc. must be placed on reverse side.] '1 NEW INSTALLATION:i1U(N septi�fdnk or seepage pit permitted if public sewer is available within 200 feet,) 7 ----------_Liquid Depth------- PACKAGE TREATMENT^" [ ) r SEP..r NK ['l Size---'r 1'------------------ ------------ q - -------------------- (}f/ 6 ty, - �� ✓��T pe..----------==---- Merial.i��?lJC` ly?...-_No. Compartments - � `J ( _ : r F t✓ yhJ �' Foundation- �. Prop. Line--57q' W istance,�fio neares#'Well�?��,� ---=------ �-------,-'---- - � � - �_ r ,, i / Total Length _- - ,., -- Iter Material ,1 LEACHING LINE .. [ 1 No. of Lir:>'es.... Yp-- -----'�.-�" -.Cen throf each line.-- :-�- -- _.._-�_7 � Box 7�_...-.-.7 a Filter Material-✓ . --..Depth Filter if �� ! 'Foundation f S-�----------------Property Line---- -----------------. Distance to nearest: Well_-._._- -.-.a" } Rock sled N Y ' . v El SEEPAGE PIT 11 p Filled Depth-I'D .-- ---Number Yes No Water Table Depth--------------------- -----"�------------------------ 17Rock Size... F ( Prop. Line__- D-------------- Distance to nearest: Well..`1�-_______ ____________________ -------:Foundation--- ------- - -P REPAIR/ADDITION (Prev. Sanitation Permit#--'//��------/-•-------'--:-- -- -----:Date.----------,----------------------------------- 1 Septic Tank (Specify Requirements)_.-------- t C✓ ( Disposal Field (Specify_Requirements)_..._.._........... . .. ......... ---.--L-�D-- �- - ----------------------- ------- r --- --------------------------- --- ---'--------- --------- -- ---------- ----------------------'------------------------- ----_---------- - ----------- _ j (Draw existing and required addition on reverse side) I hereby certify that'I 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: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to 6ecome, subject to Workman's Compensation laws of California." . �r F p , iH�ri� 1 t� i- ---------------------- Signed- ---- Title ------------- -------- 1 (lf other than owner) k FOR DEPARTMENT USE ONLY' U APPLICATION ACCEPTED BY------ 7/--- -- ------- ----------------------- ----- -------------DATE.--- - DIVISION OF LAND NUMBER.------------------ --- - .-•-----DATE------------------- ---- -- --- -------- ADDITIONAL COMMENTS-------------------------- - -- -•------"--- ----------------------------- --------------- -------------------------------- -------------------------- ------------------------------ -------- ------------ ------------- -------------------------- - --- - --- ---- ------' Final Inspection b �-� - --- ---' -- ------------ ---------' ---Date- Final f rig 13 2a SAN JOAQUI OCAL HEALTH DISTRICT F&5 216 REV. 7/76 W 1 C 4,�,Z