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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT r Permit No------------ ------- - --- -------------------------------- (Complete in Triplicate) ---------------- - - -- ----- ------- --------- -- Date Issued_.�_�.�.7:--� This Permit Expires 1 Year From Date Issued -•--------- ------------------- mit to the Application is hereby made to the Son Joa Joaquin LocalOrdantan District 549 and rexisting Rultes and Regulations: work herein described. This application is made in compliant Y -k C � TRACT JOB ADDRESS/LOCATION W C`� t _f �_ � IN - GENS Phone,? 5----------------------------- ------- Owners Name fFr -1(�_-.-S__..-_ -- F City._ l Zip . �,o Address. ['�--.�- AAA,J, -----------.--- --- - one 3 ...... - License #" ° ----- --------------Ph Contractor's Name__ '-- ---- � `�t � �� Installation will serve: !Residence Apartment House.❑ Commercial ❑ Trailer Court :❑ Motel ❑ Other-------------------- -------- ---------------- Number of bedrooms.__. ---Garbage Grinder____..--.___Lot Size-.-__� '' ------ ------ ----- Number of living units:- --�.-------=t , ----------Private ❑ - Water Supply: Public System and name----------------------------------------------------- . Character of soil to a depth of 3 feet: Sand F1Silt❑ Clay 11Peat F-1 Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material._.---------If yes, type-------------------------------- i y� - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) it permitted if public sewer is available within 200 feet,} NEW INSTALLATION:' (No sep4ic tank or seep ge p p - Liquid Depth______________________ SEPTIC TANK [� ` G � �G��^� - - PACKAGE TREATMENT [ ] Size_--- --------- ry Capacity�f - -Type _Q" Material f .-�Cr�.t.ANa. Compartments------ --------------- -------- Di ance to nearest: Well----=1f1 ----------Foundation-_10 ---------#-'Prop. Line_,_ �`*ft rw ------------------- / l .Length of each line. = ---------------Total Length- J LEACHING LINE [eNo. of Lines_._--- -------------- g a_hyi- ------ ,r D' Box :.':Ty: e Filter Materia[ epth Filter Material_____ -� `.- -- X A t.. i 15V ------ Distance to nearest: We ----- ---------------Foundatio '- ----- -------- Property Line_--_-___._ --- 4.� Rock Filled Yes �1"o ❑E, Depth_ , - `Diameter_'_ -.-------Number---- 3----------- ------ SEEPAGE PIT [ J, ; — _ a: , "." - � RockiSize Water Table Depth-__:"_ Distance to nearest: Wel!' Foun�a`fiion'" "'=a' Prop. Line ' Z ~ REPAIR/ADDITION (Prev. Sonitatibn Permit#_'-------- -------- - ---------- Date--� s-- - E ` q l 3A _ t ----------------------------=------ - . __. ----- �== == -- Septic Tank (Specify Requirements)_-_._ . - �----, Disposal Field (Specify Requirements)-, ---------- ---- --------` t-- ------ _ + - ---------------------------------- � f ------------- ------ -------- - --------------------------- (Draw existing and required addition on reverse side) i I hereby certifythat-4 have-prepared this a plication and that�the work will -be done in accordance with San Joaquin County 1. p Ordinances, State Laws, and Rules and Regulations of the San .Joaquin Local-Health District, Home owner or license agents signature certifies the following: "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 - mpensation�Eaws_.ofwCalifornia."____ ---- Owner Signed ------------ - ---------- ------- I _�sa�v-r _._cam { ------------- Title --- - ------------- (If other than owner) .. F R PARTMENT USE ONLY' k ' .- DATE._ �7 . � APPLICATION ACCEPTED BY---------__ - ------------------------------------ ----DAT - ------------------------ -- -- DIVISION OF LAND NUMB --------------------------I -------------- --- ---- --- ---- ------ -------- ------------------- ------ ------- --------- ADDITIONAL 'COMMENTS__-____-------------------- -------- --------- ----------------------------- " ----- -- --------- ----------------- ---------- --------------- - _ Date-- Final Inspection by----- -------- --- --------------------------- F&S 21677 REV. 71- I EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT