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FOR OFFICE USE: FOR 1 Y f OFFICE USE: f APPLIGATION-FOR SANITATION PERMIT ------------------ -------- --�- --IAA--------- Permit No.----��- 71 ,� t i' � (Complete in Triplicate) "" ----------------- ------------- - -A��v Date Issued.................... ._-__-_-._------_--._------------------------------"-- This Permit Expires 1 Year From Date Issued v 2`7° �F f`J/L/ ,4-4/ - ' `f'7 Application is hereby mad o the San Joa m Local Health District for a permit to construct and install the work herein described. This appli/ation is�mra_d in iac wi.th County Ordinance No ounnttyOrrdinanceNoo 5`49 and existing Rules and Regulations: rNSUS.TRACT------ --------------"-"-.-ljatt / ff A JOB ADDRESS/LOCATION M-0-JA............. -i' -, ."-. Owner's Name------- - Phone f � / A ` Address-----= � _ City- e!� £G ZAP Contractor s Name_---/.�-,.- -- //_ "". ... 9L;-157-- Phone_._ /' L -l�Fs r , X2-` --_Licensey Installation will serve: ' Residence ❑ Apartment House Commercial ❑ Trailer Court t Motel t] Other". 1R' Nuebeof Viviita4� Nmb'ero`f erom , ' rbage Gfrindfeh--- .---- �oSize e "-". L1� - ------------------- Water -------!- --" WatSuPPY' Public System -------------------------------------------------------- . . name---------- t J---------ems �6 _ ----=----- ---------------------------------------------Private' Character of soil to a depth of 3 feet: , Sand ❑ `Silt❑ Clay ❑ " Peat [_j Sandy Loam E] oClay Loam Hardpan' ❑ Adobe'❑ �' Fill Material------------elf yes, type-------------------------- (Pl6t 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 or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ]---SEPTIC TANK [ ] i s ' Size---. - - ----:--- -------------Liquid Depth.- -�-------- - - 1`r Capacity—-_.-'-------Type-----------------------Mate-rial------- -' --------------No. Compartments-------------------- �1 f •Distance to nearest: Well--- ------------------=---- --------------Foundation-----.._. ,-..•_.----------Prop. Line-------------------------- "� LEACHING LINE [ ] No. of Lines._------- --------------._ --- Length of each lino.-- t-------- -__'-.Total Length :--.----.---"-_--,-_,---_.-__-------.-- 'D' Box------- -Type Filte Material--------------------Depth Filter Material------------------------------------------------------------:--- t Distance to'nearest: Well--- ------'-----------------Foundation-----------------------------Property Line-.-----------.---------------------- . SEEPAGE PIT 1 ] Depth--------------_Diameter---_--------"----"Number-----.-------------------------- Rock Filled Yes E] No E]Water Table Depth------ ------- -----------------------------------------Rock Size--------------------------------------------- -- t Distance to nearest: Well---------------------------- -----Foundation--=------ ---------------.Prop. Line..---------------------- REPAIR/ADDITION (Prev. Sanitation Permit#--.-----=-------'---------------------------------- ------------ ---- ---- -------------------1 Septic Tank (Specify.Requirements)----- d � .�� (C"� f --- �� ` f ' t .; Disposal Field(Specify Requirementsl-. I, ��- ------------�� ------------ --•-- ---------- • fZi 1e'°J:L-{---- -------------- . . ` 'ice . -- ----------- -----=------------------- ------------=------- ------------------------=----------------- -----------------------=------=------------------------ ------- --- ' (Dr`aw existing 'and required addition on reverse side) r 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, I'shall not employ any person in such manner as to become suble to Workman's. Compensation laws of California." .5? ----Owner I Signed----------- -- _ . . By------------ ---- -------------------Title---- ---- --- (If other than owner) t r OR DEPARTMENT USE ONLY APPLICATION-ACCEPTED BY--.- -.. - " -_---- ---------------------- .-:DATE..--- ---------- DIVISION OF LAND NUMBER ------ ------ ---- p' --- .-- --------------DATE ---------------------------- ------------------ ADDITIONALCOMMENTS--------------- ------------------------------------------------------------ ---------------- ------- ----------------------- -------------------------------- r --- ----------------------- � t i ----------------------------------------- ------------ -- ---------------------------------------------------------------------------- --------------------- -- -------------------------- ------------------- -----------'------=------------------------- --"() C -------------------------------------------------------------� - Final Inspection bY�-----------:.-� �--- ------ --------------- ----------------------------------- ------Date.-=-----�f- ----------------------- ------ EH is 24 SCAL HEALTH DISTRICT Fa_21677 REV. 7/76 s 1