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FOR OFFICE USE: . OFFICE USE:OO APPLICATION FOR SANITATION`PERMIT FOR R - -------------------------------------------------- 7 (Complete in Triplicate) ` 1 Permit No. _.__,:,__ Date Issued_._7`-___._-77 _.__ .. ........ This' 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 rdinance No. 549 and existi g les and Regulations: t JOB ADDRESS/ OC N_.t - -- -- ---------------- - --- .CENSUS TRACT = Owner's Name - , --- Phone--------- -------°�----- Ar Address--- 0R - : -------------City +--... ZiP/�� . Contractors Name-- --------------` ---�------- � ..� Ce Li 072/ Phone- Installation hone '` nse #, '� Installation will serve: ResidenceAp❑art e>t-House.❑ ❑ Commercial 'f Trailer Court Mote ❑ g ;... ;.. Number of living units:_____/-.. -___Number of bedrooms- ----Garbage Grinder-- ---------Lot,5ize � ._._... ,-_.__ Water Supply: Public System and name - _. _ _ _ ..---_ '`--------Private I __.•� Character of soil to a depth of 3 feet: ; Sand ❑ ,Silt❑ -Clay ❑ Peat❑ Sandy Loam` Clay Loam �] t Hard an. Adobe. Fill Material-------------If yes, type {Plot pian, 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 seeps e' pit•permitted 'if"public sewer is available within 200 fee4,) i PACKAGE TREATMENT [ J SEPTIC TANK [Le " " "Size---f- 1 ~-• '""____.._- Liquid Depth.___________._�.__� s Copacity 19- _Q-Q-----TYPe- - - Material- - -- ---No: ;ompartments-1-------a.r--------t_--' Distance)to anearest: Well.__--- -_-__--___________________Foundation//___ -------._Prop. Line.,S- -s ------ 1V LEACHING LINE. [4,-"No. of Lines------ ----------------Length of ach,linEs.__ _� �'_ ---- _,Total .Length--- -�_ _-____-_..__:------ __ 'D' Box. Type Filter Material;�_0 ?_* Depth Filter Maerial___f------------ ------;__-____y__________________* Distance'ta earest:,Wel!__ __.__ .Y_ F,oundat.ion__ __ __-___Property Line __ C Y Y SEEPAGE PIT [ De th-__ __.__.___Diameter ❑L,� p 4__ :---Number----- ---------- Rock Filled Yes No + - - ----- -------------------------- ---- --- --- --- Size ; Water Table :Depth.___- __��.._ �_ _ Rock Size__-¢�__�,�______________________________ Distance to nearest: Well-_------------- __ __U______.______-__-_-_Foundation____- __ _ Priop. Line-_ REPAIR/ADDITION[Prev. Sanitafiion;iPermit#_= ------'_------ ----------------------------------Date----------------------- --`------------------ Septic __ -Septic Tank (Specify Requirements)------- = s - - --------------- --------------- Disposal Field (Specify Requirements) ----- -------- ------------------------------------------ ------------------------------=-- --------------------------------------- - -------------------•--------- --------------- ----------------- --------------------- --- ------- --- ----- - - ------------------ --------------------------- --- ---------------------- -- ----------_____________________________________._--_____-____-_ ___ __________.__________-________-___-_________.___ �-------------,.____.____.___________.___________ --- ------- .:___ (Draw existing and required addition on reverse side) - I 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: "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 of Signed---- 1 .r p. ' to become subject tp �`: me sationn laws,of California.', g - - - ---------- -:Owner BY f Title----- - �- ---------- + wrier[ . . ` .'. . _..: - _ 'FOR DEPART"ENT USE ONLY APPLICATION ACCEPTED BY DATE. 7 { - 9 DIVISION OF LAND NUMBER ---------- ---- ----- ------------------------------------ - .-- --- :-------------------------------------------------------------------------. DATE. ADDITIONAL COMMENTS ------------------------------------------------------- ' ------------------------------------------------- --------------- - ------------------ y ----------------------------- -- _______________________________________________.__.___--________________-__.______-_________-__ ----------------_--------------------------------------- ___-______ __________-__-____--______ ` -- -------------------- ---------- '-""--------'.._ ----- -------------------------------------- --------------------------------------' -----""_-_------ - Final Inspection 6y::__ �.�. ---------------=--------------------- Date-71 EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F85 21677 REV. 7/76 z•#r.: