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FOR OFFICE USE: V M ' FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .................................... _.. Permit No.7.6�t.4t f 5� - " --- (Complete in Triplicate) , ---...--.......... ...--- - - Date Issued...^...#--r2.8'� ._-----_--".""----_"_---__-.-.-_--."".-_--.-_--.-- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct andinstallthe work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION....... .... - c _.....--- - - CENSUS .TRACT.... _......._.s_...._...... Owner's Name.,_:.---�±�-.. ..d-Cly p - - ' ...._Phone. - - '- - Address............ �-� - - '+' --.-.,City - -------- ----.---Zip. ....----.-------------- . A .... License # A,yZ --Phone----_------- •---------------- Contractor's Name-------. -. ....... .:......kit �-- ✓ --r.— - -----Lic Installation will serve: Residence_( Apartment House Commercial ❑ Trailer Court ❑,. ... . ':: .:. Motel ❑ ;Other----------- = - ..... ......... Number of living units:-----Z........Number of bedrooms.._ ._.Garbage Grinder...........Lot Size-__--.."_,". ....""".....;- --------- -------- Water Supply: Public System and name---- -----=--- --------------- ----- ................................ --- ------..._-------•- -------------- ---------------Private ❑ Character of soil to a depth of 3 feet: Sand E) Silt C3 'Clay [3Peat❑ • -Sandi y Loam❑ Clay Loam ff�' r Hardpan ❑ Adobe ❑ .Fill Material..r._":.....If yes, type... --------------------------•- _ _ , .- a.. _ , (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 it permitted if public sewer is available within 206 feet,) / s PACKAGE TREATMENT [ ] SEPTIC TANK l x�0.... ?r.-._----------------:"-.--.--Liquid Depth.-.-_v--- ........... , ! Ca aci &e O T e.. LMaterial .- - - No. Compartments-_:?! :........................ Distance to nearest: Well._::_......I qQ... _----.-Foundation.:_"_..(.4?" -,••Prop. Line:,...../ ............. LEACHING LINE; . I!j ,.No. of Lines.t.....:3... length of each line--------"+ ..I-ct------.---.Total Length ------------- - r YPMated - � . P - r .... _ -"Di meter.'.--- -. N-----Number.----------- -1-------- P Rock Filled Ye [oJ No❑ D' Box..."J. -T a Filter Material... _._ _ _.De Depth Filter Material.._""..P9.._................................."......_,. l - Distanceto nearest: Well.....�f7�.. ._. . _ Foundation"...... Property Line."........_." ......._. �: SEEPAGE PIT {s] Depth" .- �'r a ' !�N ri Water Table Depth--- -----— -i?� I--------------- - ......Rock Size ^" - - - Distance to nearest: Well..... _------__Foundation.":".L.tt "-.....Prop, Line -7 ..... REPAIR/ADDITION (Prev. Sanitation Permit#..".-"---------------------------...... ....... --Date---_--..........-"----. ---_----_---------) Septic Tank (Specify Requirements)_------ -- -> ....--- . ------..........---'----.... . •.......... ............................................................... Disposal Field (Specify Requirements)------- ----------- . ................................................- — ..............-—. ......... . .... .---------- i a - - ---------- ---- ------- --------- -- - --- ----- - ------------:......................I....... ........ . . ................ ------:.......................... -------- ----- . ..--------------- ------ ----------'-�-------- ----------------`- --..:...-----....:..---------------------------------------------------------------------r--- _ _. ( 'y' (Draw existing and required addition on`reverse side) 3 1 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. Home owner or licensed agents signature certifies the following: _ 1 "1 certify that in the performance of the work far which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compens tion laws of California." < __.__. . " _". _ OWner A It By...."".- - --- -----othe- ` irle... - (If r than owner) FOR DEPARTMENT USE ONLY' APPLICATIONACCEPTED BY_G,:.---- ------ .. .. ............ .. ........................................ ----------DATE..?---Z.:!7J...----- ---------... DIVISIONOF LAND NUMBER.. ...._..:............ ........................................................... -- -------------DATE........ ----------------- --------."".------.- ADDITIONALCOMMENTS....-- ----------------- ................ -------------- ... -----.................. ...... . ......----------...._...----------------------------------;.:. :---... ....... . ......... -...._----- -- -----_------ .......... - .-- ...........--......--..... ......•...........-__.... . ---. ------....""._..... ... EJOAQUIN Date. - -_24 ---------' Final Inspection•by: :.e:;_ - ... �� y ..0113 24 LOCAL HEALTH DISTRICT res 21677 Rev. 717e'3A