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r ,FOR OFFICE USE: ,� ._ FOR OFFICE USE: Ic- AP- ATSANITATION-PERMIT ---------- =--------------- --------------------------- �- '� .';�`� : I ' Permit No.__7.7'_33 (Complete in Triplicate) - -- ------------------------------- ------------------ '-.- 1 ' Date Issued..... 1 ___- 7 _________________---------------------------------------- This Permit Expires 1 Year From Date Issued Applicafion 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. 544 and existing Rules and Regulations: 3 E JOB ADDRESS/LOCATION--- � - - ---- ------------------ ----- -----------------------------------=----CENSUS TRACT--------------- -------------- _ # , -- ---------- ------ Owner's Name ----- Phone --- Owner's Y- --- ---- .-------- - city, - y, '� �� '._ Address----.:� a -- Cit :Zi Contractor's Name ,/ - ---- ---- ---- License #_�e�) � `�Phorie_..'7��-'------- ---/--- Installation will serve: Residence�I`-Apa'rtment-)-louse;❑ Commercial ❑ ,TraileriCourt j "Motel ❑ Other- ----- - , r Number of living units:_.-V ____Number of-bedrooms Garbage Grinder - Lot Size _/`__. -------------------------------- Water _ ` F .- __- _______ Water Supply: Public System and name---- ---- - -------------------------------------------------- -------_- ---- '-------- ... ---- ----- .-_�__--Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ , Adobe)` Fill Material__.__'�"`.7T yes,type____________________________: {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) j NEW INSTALLATION: No septic tank or seepage it permitted if ublic sewer-is available within 200 feet,) f pp p �f f P � � ..� �. PACKAGE TREATMENT ]-,,SEPTIC TANK � S. 7_�.�___r�9----- _--------- ------------Liquid Depth___/ ____-_ 1� apacityl-;? `y 'TYp µ Material - ---- -- ,No. Compartments.-`- -------i:;. -------------- 6 r x Distance to nearest: Well---- ------------T._____.—�__=�-.Founclation__v-7 --------------- Line -_"r--"`------_.__ ...., �/ . Q-- LEACFIING LINE .T. o. of Lines--------i�__________________Length of each line. .__Q-C�._-___._____,-_-_.Total Length -._�d_ __________,___---__ - } -- .- r D' 'Box--------------Type Filter Materral�--- -- 'Depth Filter Material----- -------------3 ---- ---------- .DistancE+to nearest; --------------Foun'aation_giO_______T -------..Property Line ---------------------------- 4- SEEPAGE --- --- _---------- SEEPAGE PIT Depth__c;�,_$7_;..Diameter_ _ -------- �r J Rock Filled Yes No Water Table Depth �----------- —Rock Size__ r Fistance to nearest: Well.----- �1,...____f-_______________Foundation_l ___ .__-..Prop..L'ine_ ---------------- REPAIR/ADDITION {Preva Sanitation Permit#-------- --- --------------------------------------Date__.___.__ ______________________--____:`_____) L 1 �-; SepticTank [Specify Req irements]------------------------- ------------•-=-------------------- ------------------------------------------------#------------------------------- Disposal Field {Specify Requirements}------------------ - -------------------------------------------- ----------_------------------------------ ------------------------ ---- ' --------------------- - - --- Pr a ` (Draw existing and required addition on reverse side) I hereby certify that I haye'prepcired this application and that the work will be.rdone in accordance with San Joaquin County Ordinances, State Laws; and Rules_ and Regulations of.the San Joaquin,Loc'al Health District. Home owner or licensed agents signature certifies the following: r a "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 bje t to W an's Compensation laws of California..'.' r. n• Signed ` >' Owner # BY-=---- - ------------------------------ Title------- - ----------------- _E Ilf other than owner] 1. FOR DEPARTMENT USE ONLY, APPLICATION ACCEPTED BY---- ------------ ------------------==------------------- DATE._ '7 = � � �� ------- DIVISION OF LAND NUMBER. - ------------ ---- 7-------------- --DATE = ADDITIONALCOMMENTS ------------ ------------- ---- ---------------------------------- -. --------- ------ --- -------------------------------------------------- ----------------------------------------------------- ----------------------------------------- ------------------------------------- ----------------------- --- ------------------------------------------- ------------------- -- --------- ------------------_ ----- _____--._-_.___________________________t ______-________._________________._ _____._ ___.__.______.________.______.__.._________._..____________.________---------- ______________________________________ + .___ ------------- - -- ._ __ ____-- -- - ----- f --- -- ------------- -- ------- � _Date_ � �fFinal Inspection by::_-'- `=- =--- --- -- --- ---------- = -'4� _ EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT FBS 21677 REV. 7/76 3M Q