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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --- --- ---------------- -------------------------- - d (Complete in Triplicate) Permit NO-9--.15.6- -------------------------------------------------------- --------------------- ----------------------------------- This Permit Expires l Year From Date Issued Date fssued,54-'_ 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/LOCATIO ----, -'meq_ 7-f-417------ . �' , = ._ CENSUS TRACT --.- Owner's Name-------- ------- - ---- ----- - - +--- ------ ----- ---------Phone----------------- Address---------------1:::�77 --- -- -`" �` City -- --- L--j�-- C�------ Contractor's Name __ �L�'� _-4� License #----�'-2�(-� --Phone--------------------------------- installation will serve: Residence J Apartment House.E.] Commercial ❑ Trailer Court ❑ Motel 0 Other_ a.._,• ---------------- i nx Number of living units:_____._-------Number.of.bedrooms------ __Garbage i•inde :_,.__..___,Lot Size__- : ._____--_-------_ I Water Supply: Public System and name--------------------- ------- -------- { ------- -------------------------- ----------Private El Character of soil to a depth of 3 feet: ` Sand ❑ Silt[] Clay ❑ Peat❑ Sandy Loam [] Clay Loam ❑ I 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.) t NEW INSTALLATION: ' (No septic tank or seepage pit permitted if public sewer is avrfilable within 200 feet,j PACKAGE TREATMENT [ ] SEPTIC WANK ['] Size---------------------------------------------- -_------------Liquid Depth------------------ --- - -. Capacity---------------------Type: = = = Material--------a l !-•'No Compartments---------:---------- Distance to nearest: Well----------------.---------------------------Foundation.----"."l-----------------Prop. Line------------------------- -- -- LEACHING LINE ...T " �( ] No. of Lines_.�=----=---------------------Length of each line-------- --------'--:---.;---.._Total Length._'----------------------------------- ' { 'D' Box---------'-..Type Filter Material_._________________Depth Filter Material_.:___.________--------------------------- --- 4 L -------- - --- Foundation----------------=------- -Property Line--- --------------------------------- .; Distance to nearest: Well________________ � -- SEEPAGE PIT j.'] Depth----------------Diameter.:_.__._.__.__._.___Number___,____._,_______- _---_--- Rock Filler) Yes F-1No ❑ 4 r _ Rock Size:. = Water Table Depth ------------------------- Distance to nearest: Well--------------------------------------------Foundation.-------------- ------..Prop. Line_------- i REPAIR/ADDITION (Prev. Sanitation Permit#_ _..__'------ ------------------ Date:-------------.--------------------------------} Septic Tank (Spec'ify Requirements) - f� ----------------------- -----------------------------------_- -------- ----- -------------------- ------------- -- DisPosal Field (Specify Requirements) - (/ L ------- --- ------------ i I / V {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: Ai "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 Comp s tion laws of California.." Y - --------- Owner I Signed B : - ----------- " Title- ----2_(,t -t-�-------------------------------- (If other than owner) yy FOR DEPART ENT USE ONLY i APPLICATION ACCEPTED BY-------- i!:�. DIVISION OF LAND NUMBER. = --- ----------- ----- -----------------------------------DATE ---=-------------------------------- ADDITIONAL COMMENTS = f EH24 Final Inspection by:- Y: F&s s -- - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1577 REV. 7/76 3M