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FOR OFFICE USE; FOR OFFICE USE: 'PLICATION FOR SANITATION PERMIT F � Permit No.. 7 -;6-; - ---------- -------- --------------------------------- ---------------------- (Complete in Triplicate) ----------------- Date Issued..(._J.� .. .97This Permit Expires 1 Year From Date Issued -application is hereby made to the San Joaquin Local Health District for a permit to construct and install w h e ibed, his application is made in compliance with County Ordinance No. 549 and existing Rules and Re ulat ':.OB ADDRESS/LOCATION. + 3- -5 Nl_v-------- -lu �_�_ CENSUS TRACT - 2 3.9 _ /S5 C�.-- t-t3�',uT S ------ ------- ----------- ---------- Phone -------------------- Owner's -- - Jwner s Name.._%_ -- t!��-------- -- Address = --------------- City-- ----------------- ------------------ ------Zi ---t--------- --------------- -------------- --- - ,. � Y X 23-_ ��l------ �•l�RG�tve ------------ --'------License #.,�_�'3.r?--------------Phone----- uontractor shame-- -----7-�� ---- - ----------- ------- -------------- Installation will serve: 'Residence OR,''Apartment'House:'❑ Commercial ❑ Trailer Court ❑ Motel-,E] Other------- ---- ------ 3Ck3 ' Zdo Number of living units:----------------Number of bedrooms...._.__ ---GAage Grindev'__________..Lat Size---------------------------- ----- Private Water Supply: Public System and name-- -------------- ----- Character of soil to a depth of 3 feet: Sand N1 Silt E] Clay;❑ Peat E] Sandy Loam E] Clay Loam ❑ Hardpan ElAdobe ❑ Fill Materia_.-------;;_if yes, type------------------------------ - (Plot plan, showing size of lot, location of system in relation to wells, uildings,;etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if 'public sew er..'is available within 200 feet,) r. PACKAGE TREATMENT ] SEPTIC TANK [ ] �' L� 1 [ Size---.-----�-.___� " + ----------------------------Liquid Depth_=2_._�.- F Capacity ibV v-------.T e_�tec.qS'ir----Material._w�t�C1�'�------No. Compartments---------------- ----•- p Y Yp :. 00` .� __ Distance to nearest: Well..--�-------- ----------------- _---- , V p. Line--- 5-{---------------� Fou�.a � _. al Lengthro j �v.� LEACHING LINE ( ] No. of Lines------------------------ ..Lealgjh_of each line Y-.- s -- D' Box.---.--_.._T a Filter Material-__________________De ..-Type pth Filter Material---------------------------------- -- •----------- ------------ ' Distance to nearest: Well.---------------------------Foundation_`_-------------------------.Property Line---------------- - k SEEPAGE PIT ( l Depth-------- ------Diameter--------------------Number--... Rock Filled Yes El No❑-'.., Water Table Depth---------- ---------- ----- -------Rock Sfze-------------'-------------------=---------------- Distance to nearest: Weil-------------------- --- Foundation-----------.--------------.Prop, Line.--------------------------. REPAIR/ADDITION (Prev. Sanitation Permit#------------------- --- -- --------- ------Date:----- -:---------------=:--=-------------- } Septic Tank (Specify Requirements)---------- (� ` LP <ra F�eCA3 -_._..__. ;- 3 � - Disposal Field (Specify Requirements)------ ----- ----- --- ...................,- ---------------------- -- ---f ra------------�x - - ----- --- - ------- "' 1v AT U 1�l = --- ------------------------------- r7= (Draw existand required addition on reverse side] ---------------------------- - in g q hereby certify that 1 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 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such mannerlas to becomes to Workman' Compensation laws of California." 3 1 { Signed----------- ._ ----------- - --------------------- ----------Owner - -- ... - Title �.tle{� -------------- -------- - ----------- i 1`06,61PARTMENT USE ONLY G �7 APPLICATION ACCEPTED BY---------------------------------- � '---------------- DATE -- - '----------------- DIVISION OF LAND NUMBER.------_------- --_--------------------------- - -------------_ _ r._..._ - _ - _,. :. ADDITIONAL— 'CO ----.-- ------ -- - - -- ------------ ------------- ----------------------------------------- --------------- *SAN ------- ------------------------------:-------------------------- --------------------------;P`:: 7 Final Inspection b ------- Date p y:- - ------------ - F&S 21677 REV. 7/76 3M EH 13 24 JOAQUIN LOCAL HEALTH DISTRICT