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FOR OFFICE USE: FOR OFFICE USE: ;� APPLICATION FOR SANITATION PERMIT � 7 � - ie -------------------------------- Permit No.. 0--�./ {Complete in Triplicate) j ------------------------ ------------- -----------" Date Issued/--- _ 27 This Permit Expires 1 Yede.From Date Issued a 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 Ordinance No. 549 and existing Rules and Regulations: y F �. -- --- ---CENSUS TRACT------------- ------------------ JOB ADDRESS/LOCAT ON--- 7:_ --.-`",_ �'- -------------- ---- owner's Name. - k ' - -----=- ...... :. hone --------------------------: . Address---- _ �- City -----------Zip ---- ------ i - Contractor's Name-_-_ _- '-i1— -�j� _ �¢ ❑ ou - - / c. License # - Phone . Installation will serve; Residence Apartment House 0 Commercial TraiTler Court otel ❑ Other._ ' --- ----- ------ 1 Number of living units:.- ---. -----Number of be ooms- -c�."-Gar age Grinder-.-------=_Lot Size-_.�a- _X--��,- ----------- _ l r i -----__-Private y' . .=_ Water Supply: Public System 'and name_.:___ _.__. __,_ --: - ---------------_ ----- - 4 Character of soil to a depth of 3 feet: Sand [I. Silt ❑ 'Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loom ❑ z. Hardpan E] ; .AdobFill Material-___ '------If yes, type.--------------N----------------- � t� (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.must be placed on reverse side.) NEW INSTALLATION: (Noj septic tank nor seepage pit permitted if public j�r�iys of arlable withiL1200dfDe )th--�__'_____-_ PACKAGE TREATMENT ( ] # SEPTIC TANK S. --- --- ----------------- G P r i f (•�,�:-_ No: Com artments___---.--, ---- - Ca acct_:__ T r �v � ._Material = ` P . P Y'- YP --------Foundation:-'- -�'------------Prop. Line_ �r- Distance'.to nearest: Well 1 ' —=- -^.�.�ten' // ::.Total.Ler gth. Dl_ -- ------------ - --------- �jl gth of` ach line.- l- d- LEACHING LINE No. of Lines_,___ 1__:�- -- -- --.: All : k, D Filter Material _ ------------------- Distance, ----------------- -• , Depth , Distance,to nearest: Well_. -_ Foun f ------ Box Filter Materia -- �_- -_. , a E r i --------.Pro Property Line---,: �. ! - --- - dation---;��--'---- P Y - i �, 1 - >•-•�s . 3.4 rI . 1 Y ' - Rock Filled SEEPAGE PIT ` Depth _- .__Diameter.-- - '_.___ Number '-- ------------------------ } !I iiR ; k Yes No ❑ Water Table°Dep'th ----- �--nock Size r f s D i 'Dist ince-to nearer : Well--:-- ' = Foundation �� Prop. Line - - ` ' �� REPAIR/ADDITION (Prev. Sanitation Permit# -------------- ------Date--------------------------------------------------- Septic ------------ -------: ----- ---------==---- Septic Tank (Specify Requirernents)-_____._._ ----------------------- - P------------------------------- Requirements) Re uirements)------- - -------------- ------------- Disposal Field (Specify. Vin_. y# ---------------------------------- -------------------------I ------ - . ' T � ___. ..__. _. 1j_ __ _ S I f �-�. t -- ------ ------------------------------- --- o .f . t r (Draw existing and required addition on reverserside) >f t } 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. Hoene owner or licensed.ogents signature certifies the following: "1 certify that in"the performance of the work for which this Permit is issued, I shall not employ any p rson in such manner as to betom 'ect to .Wor, 's Compensation laws .of California.'.' � ---------O..wnar_ r Signed-----'- / Title s � _ it ' ( {If other than owner) I I DEPARTMENT USE ONLY' t DATE1!77 7 ------TAPPL ICATION-ACCEPTED' BYE _ '�` -- ` ---- - - DIVISION OF LAND NUMBERI-----------------`----------- i-- - -- ---- ----------------------------------------------------- ADDITIONAL =' ADDITIONAL COMMENTS--' i ---------------------- ------------------.h J E __________________________________________ ____________ ___.__e________.--_ ________________________ - . -- -------' ------- ---------7-- '--------- Fina---------------------- - I l � t. - - ---------'�- -----------' - - `---------. --Date ---- - '-��--�"%-------' --------- Final Ins ection,b --- ------ - -- RH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 RE (!i}yf,�