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Ei \ FOR OFFICE USE: `FOR OFFICE USE: \\\ APPLICATION FOR SANITATION PERMIT - --------------------------- ------------ --------- Pe�m�it' No _�_�'_fid— _ f I (Com;plete in Triplicate) ---•---------------------------------------------- This Permit Expires 1 Year From Date Issued 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 Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATIO � .- -..- ec.. j ----- - CENSUS TRACT �fOwn _. ... •� ,. -.. ,. s er s Name ---- ------ -- ------ ------- C: -Addres -----Zip ---------------------- -.-s=- - Contractor's ------ - tHouse.[-] -- ----i='----NL-i-c:-e'n-s-e• #2-Pt`5t_,__❑_P hone-'y6k__ Installation serve: Residence ❑ Apartment House.❑ Commercial Trailer Court ❑ ;.. r' 4 Number.of bedrooms' Ot er- ba a Grinder-.-:._-_. ^Lot i Number of living units:__- - _- �Garg Size--__.__i .X---Q___- _- Water Supply: Public System la nd name---•-------------- ----------_ ----- ------ ------ -- --------- -----------------Private'❑ Character of soil to a depth of 3 feet Sand L Silt ❑ ;Clay ❑ Peat ❑ Sandy Loam (�:+�.-Z'6y loam ❑ F .._If yes, type = ---------- (plot b . Ip ❑ ; Adobe Fill Mterial -_-. __ (Plot plan, showing size of loot, location of system in..reldti n to wells, buildings, etc. must be placed:on reversWside.l 1 4 1 I ' 1,.A . .. NEW INSTALLATION: "(No- sepfic tank or seepage pit permitted if public sewer is available within 200 feet,) i PACKAGE TREATMENT SEPTIC TANK 4-", .Siz ":-------S :.X.- -------------------------f�__:______Ligi'd"E�epfiEi .519 --------- r " ti ' k �.. -_ -__-X Capacity./LGQ----= YP . aterial -:----.No. Compa-rtments_-------- ----- ---------T e. M 1i Distance to nearest: Well_'.______. _ -------------= -----Foundation- � # Prop. Line- .--- .� LEACHING LINE, No. of Lines_-_._.i._`. ___--------..--- € g (- . .. F�g�th of eachLina - '-----_-,-_Total en th. --- ----- -------------------- :'D' ----------------`-- ;D' Box-- __`7y_.Type Filter Material'-� `•-__-Depth Filter Material------A�-_ � -_ -.--. 4 4 k Distance to nearest: Wella-_ : '-.-------.---Foundation.---. .-Q Pro ert Line.-:- j 3 - i< ------ Property - -- ----- . SEEPAGE PIT Dep --10- Diameter..��X.-��N;umber-- --:-- . - x.$.:Rock Filled Yesv No ❑ Water Table Depth-------------- --#-._--____.Roc ze I lc., tin -------•-- F Fouridation ----------------------- Prop. Line- '--- -------- I ;f -- REPAIIR/ADDITION Prev: SanitatloniPermit#_--____�-__------------�� s '! istance #o riearest:'We e-.._-____--_ - r A = :,.� Septic Tank (Specify Require i ents) . ---- -------- - Dlsposal Field {Specify Requirements). - --------------.------;----------------------------------------=- -- ------ ----------------------- -----! f 3 - i, ------- -- - ---- - It ---------------------- ------- ------- ----- --------- --------- --------------------------------------------- : (Draw existing and required addition on reverse side) I hereby certify that I haveprepared this application and that th wark will be done in accordance with San Joaquin'County Ordinances,` State Laws, artld Rules and Regulations of: the San Joaquin Local Health District. Home owner or licensed agents signature certifies the following: t "I certify that in the performance of the work for which 1this permit'is issued, I shall' not employ any person in such manner�as to become subject.to Workman's Compensation_ laws. of California." Signed ----=-- --- - -------- ----=-----------= -----------Owner BY -.Title-----=- ---- - r. r. ------.---- �1----- --- tlier/than:owner) h s. ....... "' FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED iBY:L. = - 'DATE D �- J7 -------------- --- - DIVISION OF LAND NUMBER::I------=........-------.---------------------------- ------:-:--------_:---_ -----------------------------_DATE---------------------------- fi E ADDITIONAL COMMENTS....1--------- - -- - ------------------------- ----=------------------- ► 1 -- !� i '. r - ---------------------.= .== ' . _ ----------- ----------------------------:------------------- . -----'.-----.- ----------------------------------- ----------------'0 --------- - y ---------------------------------------------------------------------------- -� -Final Inspection-bY -----=-=-_ ----------------- � Date- --------------------- 4 EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT fes 21677 REV. 7i76 3M