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FOR OFFICE USE: APPLICATIOWFOR SANITATION PERMIT FOR OFFICE USE: -.,`,: ........... (Complete in Triplicate) Permit No. 7.- ....... ....9c9.......... This Permit Expires 1 Year From Date Issued Date Issued. Application is hereby made to the,Son 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/LOCATION... :L.�L�� /C�.!.....a I US TRACT z Owner's Name..._.. ..lL.!�{�� -....Cf.G........_. . ! •NS Phone...................----------- Address._.: ._._ ,__. ... , CE _.. _ .........:.....:....... .... Address._.:--- -------------� �./- f J ! •S - -`�-/L�•`^-�-f�//`��'- ...City: . . . . .... .... T1p-- , •------------ ---- Contractor's Name... .:. - ...;.J`rce...'-----'License.ZL.� -.P one .........................I h .... -- Installation,will serve: Residence r ❑ Apartment House❑ Commercial :Trailer Court ❑ f j t-Motel ❑--•"Gther................... --------------- ...... r �r Number of.living units:.............__Number,of bedrooms.,..-.--:.-..Garbage Grinder-. ,.....,.lot Size.......--....:..... --------------- -- W ater Supply: Public System and name.... ......:.... `- - .-....:..... Private r , Character of soil to a depth of 3 feet;/ Sand❑ Silt❑ Clay❑ Pear❑ Sandy Loom ❑ Clay Loam ❑ 1 Hardpan �J ' Adobe ❑ Fill Material...... ---If yes,type---------------- -------- (Plot plan, showing size of lot, location of system in relation to`4ielll/s; buildings letc. must be placed on reverse side.) j NEW INSTALLATION: (No septic tanR"or seepoige pit perm'ittea if public sewer is available within 200 feet,) i (� PACKAGE TREATMENT I I" 'SEPTIC TANK"'[�] 'j Size-_'_............ '�- ........... Depth_.....: ............... Capacity-----:......t:.. :type.:^:':.::.-r..":::Material.-=--=��-----"':::.: No. Compartments.........:--------------------- - Distance to nearest: Well.-..,,..t...'... ...___Fo1 dation. ...... .:.i........ Prop. Line.......................... LEACHING LINE [ ] No. of,Lines.r--;.. ..............T-:1e-ngth'of,eacTotal .Length.:;,,. i 'D' Box.........:..Type Filter Material .-- .-.-:-....Depth Filter Material.............................................................. Distance to nearest: WeIV...'._!.............1.....Foundation----------_-----:......'....Property Line........... ...: SEEPAGE PIT [ ] Depth.'`;:.... _.A.D.iameter........i...1- ........eNumber...:. .. ...........t a Rock Filled Yes ❑ No : i Water ... 1 r. -_ .. ! ;-Ttock Sae . ....... -- - -- --• . - "Distancetonearist Well�� ..- -'t:T.Foundahori '.:::. '.-: F Prop Line . 1 pp REPAIR/ADDITION (Prev. Sanitation Permit#...�. .- e•• . ........ .t:.... Date. ..'.?>7J-!, R a •- Septic Tank..(.S.pecify Requirements)----------'----...--- ---- . .. .... .......... . -' - -- _1 ._ 1... .- --------------- Ir Disposal Field (Specify Requirements)------ .. -_. _ _ _ -- - ---- r. ..- A .aa`: L .. .......... .....7--.:....-------------------...................-----------------........................--................................................. ..............------------- ..-. ............. . (Draw existing and required addition on reverse side! ' I hereby certify that I have prepared this;application and that.fhe work will be•done-in•-accordance with San Joaquin County Ordinances, State-Laws,_and_Rules�andJtegulaHons.of-fhe_Spn,Jeaguin Loial Health District. Home owner or licensed agents signature certifies the following:" "I Corti that in the ;�•.. � 1 n fy pertolmon a of;the wprk:'for which`Hlis permit is Isiued, I shall not employ any person in such manner Baa to became. subject to.Workman's Compensation'.laws of_Calif omip,•' Signed........i-................ ---------t...... .... .... Owner BY;........................... � .Title--- - - _......... "yc. ��` .. ..... .. f pf'other than owner) 0 , R DEPARTMENT USE ONLY ! APPLICATION ACCEPTED'BY---.G r..........'.. -: -- - ---- '' - ..::::.:::..: ' - - ------ - ....DATE'.- %....-......... DIVISION OF LAND NUMBER..............:. - ...:......... :,.,.DAT -------- DIVISION ..y ADDITIONALCOMMENTS..-.............-'....................... ........ .-- ..-.: ---"-,-..............:...............--,-....:....... ................................................--- .. . . ... r i Final Inspeciio ------------ n by::.......... ...: _ . ..........Date- � �3 4 EH 13 24 SA J AQUIN .........LOCAL HEALTH DISTRICT Fay 21677 REV.7/7iW