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i FOR OFFICE USE: ;Ivq,eX Pokon e- 6f�5 1— q o aq FOR OFFICE USE: I APPLICATION FbR SANITATION PERMIT E (Complete in Triplicate) Permit No,79_7_�,V --••---------------•------------------------------- t Date Issued.//.=9',-,7F 'i •°-°-----••---------- ----------- ------------------ This 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 the work herein described. ' This application "is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION.... e... �n - - ... C NSUS TRACT------------ ---- -------- � fi Owner's Name..:.,Je -. a- ,.aiC.�e- ��........a rl`"1--"- �}P �.. ' e .l f CPhone.� �C 50� 9 Address...... if .._ �1 1.— .-- •------- -------------- -.....Cit Y �, ." -zip-'?��+07....--- Contractor's Name.... ............ ... ..... License #----•------ ... Phone.......=.................. ............. .. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other----- ----"-------- ------------------------ Number of living units:_ - ...Number of bedrooms. .. _ Garbo e Grinder- U ys Lot Size--------- Water Supply: Public System and name..... a-..-------- �. ..--..---..--------------------------Private ❑ -------- Character of soil to a depth of 3 feet: Sand ❑ "'Silt Ej., 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 .perriitted if public sewer is available within 200 feet,[ PACKAGE TREATMENT t [ ] SEPTIC TANK [1-]"` 5�.+.. . ._D -------------------- Liquid Deptk.'_._'__6---------- ----- PACKAGE e /`e Capacity /((7thh � t " p y... - .-i��- : Yp - -- - a enol---------------------•--..No. Compartments......: Distance to nearestt : Well....../.......... Foundation..... Prop. Line_-_./1)0--------------------.. LEACHING LINE [ ] No. of Lines... . -------------_.-..Length of eac line...._ ------- -...- Total Length .. .........._..._..... ............ 'i 'D' Box. .Type Filter Material ff&A�W_..Depth Filter Material.... Iu-......_...._...__._-.:-•J--.......................... i Fou anon Property Line- ' Distance to nearest:.Well.-. �-----.-.--. ]' SEEPAGE PIT Depth.. , Diameter. - -- " 'i i --_--_ry wmer ? ---- , : ..... RockHilled YeNo------- -----\ ��Water Table ptly-.. r - ----------- ------- Distance to nearest: Weli...-A. t.y';' . ......... .......Foundation.-..L .... ......Prop, Lane---(PQ -- - REPAIR/ADDITION (Prey. Sanitation Pe mit#...._..-_. --?-.-- r:...--.Date....---•--------------------------------------) t Septic T � _� P (Specify q i --------------------------=------ - --- c ank (S ecif Re uirements)--..... ...... - . . ....... ..-... 10, Disposal Field {Specify Requirements)-11...... �, ---------------- ----------- -----•-------------------- ----- - ?(Draw existingpnd required addition on reverse side) s I 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: $ "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner ar ' to bec a subject to W A�an's Coy pens bort la s of California." Signed- -. - Owner '; b By.. -Title .................... .....--- (If other than owner) FORPEPA)tTMENT USE ONLY . APPLICATION ACCEPTED BY..----___- � ------......_.- :.,DATE............ _171 .. ---- DIVISION OF LAND NUMBER --...-- --- ............ - ------ df I _. ..---- _._..... .. ADDITIONAL COMMENTS-------------------•- -- - -- ...------......._.�--- -----------="'--- -- ------- - --- - ------- - -- :_.- . .....---- - -•--------- ........ ..... ......... _. --------------- ------------------ - --- - ... --- - -- - ....----- - . i ---------- -------- - --------------------- ---------------------- Final•Inspecfaon b Date.....------- --. --- j Y —_ EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fos 21677 REV. 7176 3M