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FOR OFFICE USE: _ FOR OFFICE USE: <br /> APPLICAT1N' FOR SANITATION PERMIT <br /> ---------------- f ------------ Permit No.__72_/_?.16 <br /> (CompleW.in Triplicate) <br /> --------------- -1-------------------------------------- Date Issued. 7,7 <br /> --------------------------------------------------------- This Permit Expires 1 Year From Datwissued <br /> Application is hereby made to the San JoaqWn Local Health District for a pprmiijo construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 dffd existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION----------------------/4X1/,041001_ ------------------- �CENSUS TRACT-----4:79------------------- <br /> r-./ - 72 <br /> Owner's Name--------- ZIOU-------------- ------- ------------ Phone-X-2-?77 ..51_F... <br /> __,oP _ - Zip----------------- ------------ <br /> Address---- -C) ------4/7Z--------------- ---- -- ------ --------------------------City----- - ------------- <br /> Contractor's Name-----------------04V1*11 /� ----------'__0----------------------------------License #----------- ----------- --Phone---------------------Installation will serve: Residen.cex. Apartment House [] Commercial F-1 Trailer Court E] <br /> Motel❑ Other------------------------ - - <br /> ------------ <br /> Number of living units._`,/----------Number-,cd bedrt)oms-%, _-___Garbage Grinder---Lot Size----------/49 I!f cxe i------------------ <br /> Water Supply: Public System and name----F= <br /> ----------- ---------------------------------------------------------------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand E] � Silt[] Clay ❑ Peat E] Sandy LoamX Clay Loam E] <br /> Hardpan)( AdobeE]. fill Material------------If yes, type________________________________ •� <br /> (Plot <br /> ype----------------------------- <br /> (Plot plan, showing size of lot, location of�ysteWA rel6flon to wells, buildings, etc. must be placed on reverse side.) <) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) c� <br /> PACKAGE TREATMENT SEPTIC TANK • 7 Size------------/,..Z 4-6_-______ _----------------Liquid Depth__-__-- -------------- <br /> 0 <br /> CapacitY/ 4-Ar.4111. Material____6&' No. Compartments-----Z--------- <br /> ------------ <br /> Distance to -------------------Foundation---/Z.7 7 ____---Prop. Line---_ 7 -------------- <br /> LEACHING 47-0- -------------- - <br /> LINE j Len ine— ------------- <br /> �o. of Lines L th of e( -.Total Length.---- <br /> er �t <br /> 'D' Boxye at il ------------------ <br /> ----Type Filter M, al &7,-?-;"epth,Filter Material--- I------------------------ <br /> yX8X 10 <br /> Distan -- <br /> K to nearest: Well /400-------- ----FoLindation-,/40---V�------------Property Line_...,r__!1L------------------- <br /> L <br /> Npth /0 _1------- Rock Fill" <br /> Nd Yes '' No No <br /> 7M <br /> Water Table J6jiW%'­--4 �WO_144_ <br /> Lite-- 72A--------- <br /> W--le- -,7'L---.Prop. --- <br /> Distance to.n64r�Wef I------A%071 ---------------*b� <br /> REPAIR/ADDITiONorew..-6onitationt Permit#---------------------------------------------------Date---------------- ----------------------------- <br /> SepticTank (Specify Requirements)-------------------------------------------------------------------------------------------------------------------------------------------------- -------- <br /> DisposalField (Specify Requirements)---------------------- --------------------------------------------------------------------------------------------------------------------------------- <br /> P <br /> --------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------- - <br /> 0 <br /> ------------------------------------------------------------- ------------------------------------------------------------------------------ <br /> ----------------------------------------------- --------------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licepsed agents <br /> signature certif ies,the following: <br /> "I certify that *?he pud—wManici of the work for-which this permit is'Issued, I shall not employ any person in such manner as <br /> to become s bie Wor"m Com"nsation laws of California." <br /> Signed-A------- --------------------------------------Owmm <br /> By-,----- ----------- -- ---------------- ------------ ---------------------------------------------------Title------------- -------------------------------------------------------- <br /> r i <br /> (jiff other than owner) <br /> DEPAPMENT USE ONLY Z oe <br /> APPLICATION ACCEPTED BY- --- ------ --------------------------- ------ ------------ -----DATE. -------------- <br /> DIVISION OF LAND NUMBER------------- -------------------- --- -- ------ -------- DATE <br /> ---------------- ------ - /_� 4 <br /> _0 <br /> 410":p <br /> ADDITIONAL COMMENTS_ 45 - <br /> -----142kieLIR-A--------------------------------------------------------------------------- ------------------ ---------------------------------------------------- --------------------------------- <br /> ------------------------------------------------------------ <br /> ---------------- ---------------- ------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------- -------------------Date... -2-------------------- <br /> ------------------ ------------------------------------------------- -7v/ ------- ----- ------------- <br /> Final Inspection by:------ -3-1 _( -_� <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M <br />