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FOR OFFICE USE: 'a -;-I FOR OFFICE USE: h APPLICATION FO SANITATION PERMIT --------------------------------- .� { [Complete in Triplicate] Permit No.7 7 ------------------------------------------------ R ' Date Issued.? 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 Ordinanc No. 549 and existing Rules and Regulations: �/$ / ' ------------- CENSUS TRACT JOB ADDRESS/LOCAT ON-.- ...-- - -- = ----- Owner's Name.-----A--- ".�2 ----- ---- ------------------- --J- P - Phone 7 - '7--vZ- �9. Address- AR¢. - .... , ---------------------------- --- --- City 7 - Zip _ Contractor's Name_..___' __"___ R �__._._..__ -------------------License #_tt°�e' 3Phone-' ?cG_. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other----------'---------- ---------------------- Number of living units:-___l- ______Number of bedrooms_----Garbage Grindex------------Lot Size__4 /`_- -/ -� Water Supply: Public System and name--------------------�/'D _ Q -------------------------------------- Private Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ _Clay ❑ , Peat ❑ Sandy Loam [] Clay Loam ❑ Hardpan ❑ Adobe W Fill Materia ------------ yes, type-------- --------_-----------"__ (Plot 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 pub)c sewer is available within 200 feet,) ��// JJ � PACKAGE TREATMENT [ � SEPTIC TANK [6}f Size----- __.E>�- - ___________Liquid Depth..-- Capacity-/--Ajb4D-----Type IU-e _Material---_--- -No. Compartments--------- -------------"--"-- / e ' � Distance to nearest: Well---._f - __. --.----_Four;dation.__ Q _____________Prop. Line-cs LEACHING LINE No, of Lines------ ----------- Length of each line._��__.�Q__e�_ �7 Total LengethQ-------------------- 'D'-Box---- -----Type Filter Material- /. L_.�epth Filter Material___=_-_.�_to-_-.______________ � t Distance to nearest: Well-1-6Q-------------Foundation.... _ -----------Property Line---- ___________________._ SEEPAGE PIT [ ) Depth_.____--.-_.-_Diameter------- .._____Number-------------------------------- Rock Filled Yes ❑ No Water Table Depth`---T----------------- -------------------- Rock Size-------- -------------------------- Distance to nearest: Well-------------------------------------------Foundation---------------------------Prop. Line ------------------------- REPAIR/ADDITION (Prev. Sanitation Permit#---------------------------------------------------Date---------------------------------------------- Septic ----------------- --------------- Septic Tank (Specify Requirements)--- - -------------------- ------------------ ------ Disposal Field (Specify Requirements)---------------------- ------------ -------------------- --------------------------------------------------- ------------------------------------------------------------------------------------------------------------ -- - (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 its issued, I shall not employ any person in such manner as to become-subject to Workman's Compensation laws of California." Signed.- 4/�` -� --�thanwner) - Owner � BY----------- Title.-- fj-- (If other FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- -` ...----------------------------------------- --------------------------------------DATE.------- = _ -------------- DIVISION OF LAND NUMBER___________ ___ ,___ �_._ __ DATE -- ----------- --- - - ADDITIONAL COMMENTS__{-,� � - - �f - - : ;'-------�---- ---��- ---------1 �4r_��,-v-iN------ - r---- 4 > °1r ------ ----- - ------ll� �'Ss ;S,ew s �' 7 /s 'l►^o�� = K�' --- -------- - - Date..._ -Final Inspection bY: ------ - -- ------- EH 13 24 SAN JOAQUIN QQ '. LOCAL HEALTH DISTRICT F&5 21677 REV. 7/76 3M