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FOR OFFICE USE: V FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT y J Permit No.- ` 7- --- (Complete in Triplicate}, � r .• ----------------------------------------- ------------- v ._ Date Issued3�--7� --------------------------------------- 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. j This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations- , JOB ADDRESS/LOCATION._L.'_�- I ----��----------- CENSUS TRACTq.._ J/c: �(JGx�,. Owner's Name. 1- - = -- ---. ----- --- - Phone l 1 r ------` to��-� Address. ------ ---- -- --..City0 Zip Contractor's Name--'— License #_3067At Phone _ h. . Installation will serve: Residence- Apartment House.❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other---------------------- --- -------------- Number --- - `-=Number of living units------- ----*Number of bedroom s_______.__Garbage Grinder_-----------Lot Size -------4 Water Supply: Public System and name------ -..--=- -------- ;.;: _ -.-.--- - --------Private Character of soil to a depth of 3 feet: rSand ❑ Silt❑ 'Clay ❑ Peat ❑ Sandy Loam []J— Clay Loam ❑ = Hardpan Adobe E]-T,-Fill Material- __=If (Plot plan, showing size of lot, location of ystem in relation to wells, buildings, etc. must be placed on reverse side.) t NEW INSTALLATION: (No septic tankorseepage pit permitted if public sewer is available within 200 feet,) ``,, PACKAGE TREATMENT' [ ] SEPTIC TANK [!� Size_______�� ._______V1��--t-------Liquid Depth _�A---,.___._ :, Ca pacit )& __Material__._ ._UA._' __.__._No. Compartments------------------------ Distance.to.nearest: Well-, h - _____._._. ----- - -_Foundation _1.��__.___. ____Pro Line_ �Q :.__ 4 r LEACHING LINE. [L4-- No. of Lines_`___ .______..,._ ,_.Length of each line_------- .........Total•Length.=---------- •----------- D' ___-_D' Box -Type Filter Material �_. � f------ Depth Filter Material__-_ �-�-_'------------------------------------------ Mal .__ -. ---. i f r Foundation_ _ _ _Property Line__, �d r Distance.to nearest: Well ----1_.,Foundation-- �. - ---- = SEEPAGE PIT Cd]' Depth_ _.--__Diameter.-_--_- - +_.___-Number-__--- _--Z________________ Rock Filled Yes>� No WaterTable Depth- ------------ -11 Rock Size /�'^ �� ' „f r , Distance to nearest: Well-,.,. f +_.Foundation`[©---------------Prop. Line- ________ tl �: � i REPAIR/ADDITION (Prev:Sanitation Permit# --- __ ____________ ---------------------Date-------------- --_: ___.__ --_------- Septic - _.- i ! ----=-------- --='-----=-_-------- ---- Septic Tank (Specify Requirements}"-----• ,. - ; - -- ` -- - `� --------------------------------------------- Disposal Field {Specify Requirements)---------- - --- - - ----------------- ---- - - --------------.:._. n --- 9 r __�_ ----------------------------------------I--------'-'-_______.---__...' ---- - ---- -----.-_-- -- - ---------------------------------° ------------ ---------------------------------------�--_---------------------------- -' --- ----- ---y----- ---�------------.-----------------_--=-----,---- - «_ w_ (Draw existing and7.eequired add xlora on_reverse_s'ide) - y-._m- . I hereby certify That l have prepared this app, ation and4hat the '4ork 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' F ' 1 certify that in the performarice'"of` hii'work for�which�thi r-permit.is issued, I'-shall not employ any person in such manner as i to become subject to Workma ' Compensation.,laws of,Cciliforniaf" A / Signed ----------- ---- ---- -- -- ----- Crvvner. - _ , -- � � � BY-> - - ------------ Title (If other than owner) 3. : rte: p :FOR DEPARTMENT',USE ONLY r_. _. i.... .... a APPLICATION ACCEPTED BY• ` # aa --- G _ - ' -- - ------ ---::-.DATE 0 `^y - ---- DIV_ISION OF LAND NUMBER: = ------------ --------- -------- ---------------------------------- DATE ----------------------- -------------- --- ADDITIONAL COMMENTS--------- -------- -------------------------.---------------------- --------- ----- ------------------------------------------------------------ ADDITIONA ---- -------------- ------ --------------------------------------- --- ----- -- ---------------------------------=------ ----- - -- ----=- --- - - - --------------------------- - - - -- ----.---- Final Inspection b — --. .. ��---. -- Date- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fos 21627 RFV, 7176 3M k f