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FOR OFFICE USE: � FOR OFFICE USE: o APPLICATION FOR SANITATION PERMIT ---------- -- - - - (Complete in Triplicate) Permit No.,77-__ _ u �-- Date _.----------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Locd/Health District forib permit to-construct and install the work herein described. This application is made in compliance,with County Ordinance No. 54.9 and existing Rules and Regulations: ._..CENSUS TRACT----------- ------- - JOB ADDRESS/LOCATION.__- --14 ------------- Owner's Name- ------------ n ; ¢ -- :. . . ' �-. Phone--------- ----- ---------- � Zip Address----- --- ------ ---------`------------ - ----- y . ors -- r -'Licens #Contract - Phone---------------------------------- Installation will ----------------------- -- Installationwill serve: Residence ,ApartmentHouse.❑ Commercial ❑ Trailer Court ❑ a a r-of living units:._.._- _.____ Number of bedr'oo�o.L.3 ____Garbage Grinder_._.________Lot Size________- __..__g .� . . Mote, ter_:. t Water Supply: Public stf e. Private : -.: -- Character o so' o adeth of 3eetSand F1 Silt Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam } Hardpan ❑ ' Adobe Fill Material_...___ __._JYf es, tYP e (Plot plan, showing size of lot, location of system infrelation to wells, buildings,',etc must be placed on reverse side.) ' NEW INSTALLATION: tank .or seep ge pit permitted if public sewer is available within 200 feet,) ' . Ca p writ Y'__:._: • r e ----------------- I Depth.PACKAGE TREATMENT SEPTIC TANK f ' TYsMater f i _ I 4tp '11':. --- I--- - - Foundation ----- ----------Prop. Line----Compartment LEACHING LINE [ ] No. ofjLines '.,_,_ ._ ` gth of eac Total L'en ! t _______Distanceto nearest: We ____ __.__ __ _----- -- Len h lina.-- gth ----- ;D' Box______._.__.Type Filter ' atelia! ._ _t____' Depth Filter Material ___ ___________ ______. . PDistanceto nearest: Well___+.- _ - __Foundation__._ _____° __ Proper`.ty-Line' ____ ___ .SEEPAGE PIT f [ j pepth __ ___ Dipmeter ___ Number ___ ' Rock Filled Yes❑ s Water Table:Depth/=----- ---- Rock Size Distarice,to nearest:�Wel1 ___ ___Foundation.: -------------- ---- Prop. 'Line_____________________ - - -`- REPAIR/ADDITION {Prey. Soriitation Permit'#- -"::'::----Ai----------------------------- --Date---�:- ------_`------ -----) Septic.Tank (Specify Requirements)----- .. - si--------------------------------------------- --------- - ----------------------- IN ---------------------- a Disp �Fji {S ecifyRequirements);_. _____._______.______-__- �f ----------------------------------------- --- --- -�--- -- _ - . � . =-- f 3' (Draw ezisti grand required addition on reverse e { � j � i 4ic tion and that the work will b done in accordance with San`'Joa lin. County I hereby certify that I have prepared th s aptfl a e q h+ Ordinances, Statekilaws, and Rules an8- ie0611:tions of the San Joaquin Local Health District. Home owner or licensed agents signature certifies;the following: 1 "I certify that int�performance of the�work for which this permit is issued, I shall not employ any person in such manner as to becom subjectt orkman's Compe tion law of California." Signed ---Owner BY- ------ ------------------- --- '------'---- -------- ---1= ------- --- -- ------ --Title i {If other than owner) ' ' r,fOR DEPARTMENT USE ONLY` [ -77 APPLICATION ACCEPTED BY_ �Gsr�.. ---- -- ---- - ---------- -------•----- ------------- ----=------==--- = DATE ___.-_ '- 5 - DiViSIONOF LAND NUMBER:------ ------- 4---------- ------ /------------------------------ -----------:-------------------DATE-------- ---- --- --------------------- ------ ---- --------------� ADDITIONAL COMMENTS_______ . _ _._�___ - - 6� --� Q ? 3e ---: '.-----------------------:------- ---------- -------------- -------------{ -�a