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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------------------------------- Permit No.7��- � 1 (Complete in Triplicate) d Date Issued-/0.-_-�_. ------------------------------------------------------ -- 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 'Z z- ' �� j �C-�---�_ e.Q.----------- CENSUS TRACT Owner's Name.__- -- - ----._-Phan/f:_5-315 f{...�,---- Address - ✓a .. G' -------City - J�� Zip �lG_L. _ : � a.�. 7-Z = Contractor's Name �4�sc,4' —License # Phone Installation will serve: r Residence [s�Apartment House ❑ Commercial ❑ Trailer Court ❑ r Motel ❑ Other------------------------- � ... Number of living units:------1-.:-------Number of bedrooms.__— --Garbage Grindar-..:--------Lot.Size_________ ________________________ _______.------------�_-- Water Supply: Public System and name------- ----- ------------------------------------- -------------------- -------------------------------------------- Private Character Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ , Hardpan Adobe ❑ Fill MaterialT.-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 perrnitted if-public sewer is available within 200 feet,} i ' / PACKAGE TREATMENT [ ] SEPTIC TANK [:] Size--✓�-'-x_��------X-�� ------------------ Liquid Depth.__'T___._-_________- ' *Y Capacity.__ 4 0 e ---Type-- ------I No. Compartments-----;�=----- r----_W Distance to nearest: Well_____------------��` -------------------Foundation---____.1_a------------Prop. Line------- LEACHING LINE, Na, of Lines- Z__________ -------Length of}each line fV------------- --,.Total Length------S 6-------------------------- .D' Box_,... -_.--Type Filter Material:__ _--fF_0------Depth..Filter-Material--------- _-�_._.._________.___.----------------------------- 'Distance _. - _--------------------Distance to nearest: WeIL_______� '.+- -------.t-D__:---._--_..Property Line_._5_ -------------- =Foundation ' T Depth--_Xf/fDiameter_-----3'_ ___.Number r777 7!7 ":------ Rock Filled Yes [ Noi[].r SEEPAGE PIT' E _ 1 t Water Table Depth.-- ------- 0,0------------------ ---------- -Rock Size. X- ------------ -e '- Distance to nearest: Well.-__-.__-- ._- _- ____ '_Foundation__s'---- ?_ --.Prop, Line---- -------------- REPAIR/ADDITION-(Prev. -------- _REPAIR/ADDITION•(Prev. Sanitation Permit#------------------------ ---------------- -.Date-------------------------z----=----------------Septic Tank (Specify Requirements)---------- ----------------------------------------------------- -- - --------------------------- ---------- Disposal Field (Specify Requirements)--- -------------- "--------- -------------------------------------------------------------- ---- -- ---------------------------------- ---- ---_------------------•------------------------ --------------------------------------------------------- _ ___ _____ ------------- ` (Draw existing arid required addition on reverse side] I hereby certify that'l 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 i signature certifies the following. * "I certify"that in the perforniance 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 Compensation laws -of. California.'.' Signed-: --------------------- :- -Owner T'tl e ByI ------- --- ------ -- _ a , - r " (if other than owner) t FOR DEPARTMENT USE ONLY ' 7._7�� APPLICATION ACCEPTED BY��- -- ----� � ��-- -- ------------------ -----------------------------------DATE.---�, - ---- --t�j. -- ---- DIVISION OF LAND NUMBER-------- -•---------------------- -------------------= ------------------------I---- DATE-------- _--- ----------- --------------- ADDITIONALCOMMENTS----------------------- ------------------------------- -------------.-------------------------------- - ----------------- ---- ------------------- --- ------4-------------7--- --- - - ---------- - ----------------------- -- --- - -- - _ -------- Final-Inspection by:-. = = --=-------------------------------Date - -------------- EH 13 24 SAN .10 UIN LOCAL HEALTH DISTRICT F85 21677 REV. 7/76 3M