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f . _ �-- FOR OFFICE USE: T FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------- ............... --------- �� f [Complete in Triplicate) Permit No..? --••-•--- ---------------------. ......... ............ t I f n ,: 'cif•, 1 ( f , -" 1 - Date Issued.............. ••-•••••• ...... ---- .................. This Permit Expires t Year From 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 �tVounty Ordinance No. 549 and existing Rules,and Regulations: JOB ADDRESS/LOCATION VF�R-�S IlC e IAAK --- ....... ------CENSUS TRACT----------------- Owner's Name..-- _.lfES Ffzee-VAxa ...: ��. - .... --- ....................................... ----- ........ Address - 2 .... i 1RTMu(L- b�iU.. -- -- --------------city-----TR .. ...._.. --.....--._-Zip... ............. Contractor's Name----- C-('5'4Z-1f*L --------- ------- 4 a�8 License #.. Phone.... Installation will serve: Residence L' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other....... -- --- ------------- ---------- ? x`12 P scws Number of living units------ ---------Number of bedrooms___- :Garbage..Grinder_= -_Lot Size------.---- - ____---___-_..._.----.-.-- -- 4 Water Supply: Public System and name--.-.-- ------ - _ --- ---------------------------------------Private E � Character of soil to a depth of 3 feet: Sand X Silt❑ Clay ❑ ,.! Peat ❑ Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material.. -- If yes, type_. . (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No 'septic tank or seepage pit permitted if public;sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANKSize_.. �' k --------------- .Liquid Depth.._.k/ .__._..._.._ [ ] . � ' _ Capacity--t.Z_ ........Type, ' .:..Material_-. ---__. No. Compartments------1?.......................... I k: Distance to nearest: Well_:---_.)qW � Jot ' ----------- --- ---Foundation-•---..... . - -- Prop. Line.... - - ........._---- LEACHING LINE { ] No. of Lines .....��.................Length of each Ilna__._ , "_p ---___ �..._Tota! Length .-�'t�Q4 -------------- ----------- 1 ` h 'D' Box....1:......Type Filter Material...1- /Z_tA--.Depth Filter Material",-....-�---------------------------------------------------• Distance to nearest: Wall...... -......'.---- Foundation----..0----=- _•,_____... Property Line....5............................ SEEPAGE PIT ['] Depth.__.......--tDiameter--------- ----..___..Numbar------------------- ---------- Rock Filled Yes ❑ No Q Water Table Depth----------------------------- ----------- ......__.Rock Size------- <�.. - Distance to nearest: Well-------------------------------------------Foundation-_..._-._....___ ' -. Prop. Line........_.- REPAIR/ADDITION (Prev. Sanitation Permit#---_-------------------- .--------- --.Date----------_------------------ ------\- 1 Septic Tank (Specify Requirements)------- -- ----------------- ' ...................... ----...._._._....--------------.-----.---- . Disposal Field (Specify Requirements)-------------------- --•------------------------- ---- --------- ------ - ,. _----••--------------- - --- . (Draw existing and required addition on reverse side) I I herebycertify that 1 have Y 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, Home owner%r licensed agents signature certifies the following: 4 "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 subject to Workman's Compens ion laws of California." E Signed-_.. Owner By----------- L. r'�n".... . -------- - - --_------- ....... .............Title_...... ----- ---- ------- -- ------ ----------------------------- (If ofher-than own r) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY................... f DATE .... �. —. -.-.-.......-- DIVISION OF LAND NUMBER...... . ..................... ......_....- .._.DATE.--- - - -- - --------- --- -------- ADDITIONAL - -- - ADDITIONAL COMMEN -r c-i._Sxs a...._ i---�Q v�./(.-..(.✓.� .�cc;er�_ ¢-�_.Ir4v�. GI -- . 1-Final I'nspection by:-...- .. -- ---------------- --------------------------- ---Date.- EM 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT el=-N677 REV. 7/76 3M ( !'A{ _J '.