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FOR OFFICE USE. FOR OFFICE USE: APPLICATION FOR SANITATION PERMITN. ........................... .. P �, -W 3 (Complete in Triplicate) Permit No.. g'=.. / . -- ------------ 4 •. ., Date Issbed./0'—_Fn .k ................ 4 -------- :: This Kermit,Expires t`Y,ear From Date,ls;ved1. 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: # -.--..-.CENSUS TRACT....._.-� ,.r w J08 ADDRESS/LOCATIO .... � •• '. r7'�1 u� '." r Owner's Name .* , � ...`. ............. Phone.......... . ZA ....... Address------ --X --Zi --- -- --- - --------- -- ---- ----------. ------....-.... ....--- - --..City---- -- .....---"`=�=-------...---... P-?-._...------- . ... Contractor's Name.... License #,f-�- ` -Phone-y-._ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ ai otel ❑ Other........ - - # Number of living units:---_-..-. !.--Number of bedrooms.... Garbage Grinder.-----------Lot Size.-..------- ................ --------------- _...-.`, .... Water Supply: Public System and nam'le..... .. r -"------ -------Private E]Character of soil to a depth of 3 feet: 3� Sand ❑ Silt❑ Clay ❑ ,/Peat ❑ Sandy Loam ❑ Clay Loam r Hardpan El Adobe E] 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 INSTALLATI.ON: (No septic tank or seepage pit permitted if public sewer is available'within 200 feet,) f PACKAGE TREATMENT [ ] SEPTIC TANK Size...41/ ----------------- Liquid Depth . Capacity..f ---Type ateria -C . .------..No. Compartments ---r�9,. .............,.ra or r Distance to nearest: Well....... ... _.Fooundation_..-��. . `-... ... Prop. Line-.'.................... LEACHING LINE [ j No. of Lines ---.-._-/.._.......�.Length of each line..---10-4---------- ---Total Length .� -.._......-. .......... ... 'D' Box..... .. "..Type Filter Material.- .. ---- Depth Filter Material-- _ �� 5 . Distance to nearest: Well-..�- - -- ---- ..Foundation........... --Property Line.................... '' 1 SEEPAGE PIT [ ] Depth---�.a'=;..-Diameter.-- ..---..Number..----/---------------------- V Rock Filled Yes ❑ N :I' Water Table Depth•------------------ ...... -Rock Size.../ ! ... �...... Distance to nearest: Well..-. Foundation...............1..... _- Prop, Line--_ ..--.- + REPAIR/ADDITION (Prev. Sanitation Permit#- ------- --------........ ...... .......Date-------•:.............- -- ..-------.----.-] t ,: Septic Tank (Specify Requirements)-.__' -...-.-. _--= -------------------- -------------------•----------- ,....:... Disposal Field [Specify Requirements)..................... . -------------- --------------------- -- ........... i --------- a ................. ------ -------------- .............. ------------- ...--•--------------------- ---- ------------ ------ :_------------- -.----- - --- ••-------- ... ............... ------ -- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I Ordinances, State Laws, and Rules land 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, I shall not employ any person in such manner as to become subject to Workman's"C'ompensatio-nlaws of Californi a Signed... -- wner , By jTitle........ ---_ -------- F (I h n owner { YFR DEP RT ENT USE ONLY 19 APPLICATION ACCEPTED BY Q.. ......DATE ...t'A .. ...7$ -- ... - DIVISION OF LAND NUMBER--------- - - --......................... DATE ...... ADDITIONAL COMMENTS.................... ...... -- ..... .. ..... ---------------------------------- - ...._.... . -- ....... . .......------.....--- ---------.:.----- --- ------- ...... -- .. I - ---------------------------- ---------- --- ....... _ ....... .. Date. .......... Final Inspection b -- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7/76 3M