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FOR OFFICE USE: -y FOR OFFICE USE: APPLICATION f:00R SANITATION PERMIT ------------------- Permit No.�e--��3 i ------------- {Complete in Triplicate) • -------------------•---------------- Date 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. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: yi JOB ADDRESS/LOCATION.J�. -.C. = CENSUS TRACT..... 3 Owner's Name.. _ rte`- .... .......... ... - (fir one _4 . Ph �/• City ... < . . .. - Zip. sr.� - --- ............ Address-. -- . ------ ----- ----- Contractor's Name- -------- .........-License #---------------------- - Phone-------_....... -- - Installation will serve: Resi ence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other........ . ------------- ------- Number of living units:..--...,3-----Number of bedrooms......-3..Garbage Grinder........ ...Lot Size.......... .......... . ----------- El Water Supply: Public System and name------- -------_----------------- Character .__-.-....._...........Character of soil to a depth of 3 feet: Sand ❑ Silt E Clay•❑ Peat ❑ Sandy Loam ❑ Clay Loam N7 Hardpan []—.-Adobe ❑ Fill Material.. ._ ....lf yes, type_-•----.-•----•--------- ------ Mot 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 permitted if public sewer is available within 200 feet,) ` PACKAGE TREATMENT { SEPTIC TANK Size ... �f.k5:.x Liquid Depth. 4e_—:Capacity. I,tO.Q-------Type.Aa.'U u� . - Mate'rialCdh .... ....No. Compartments---.-- 3... Distance to nearest:Well--- --------....-Foundation--.._- ... ...._....Prop. Line ......?--- O -_............. . LEACHING LINE No. of Lines __....f..�......:.......Length of each lines .........._�j a--...--:..-Total Length . .-_- �-- --- .- E 'D'-Box._-.`.,...:Type Filter Material ki —ADepth Filter Material_...;--...../_�...I..--{, Distance,to nearest. Well-----. —.. - -..._ Foundation---•----- ------ Property..Line----- RockFilled Yes!5�C No (✓j - + '! No Depth__.. �l�.....Diameter-- �.X'-�... Number �..--------------- Water Table Depth---------- ---- --- ------- ........Rock Size......--- ... ............... ------ ' .....Prop. Line............. ......... Distance to nearest: Well.......... .... Foundation...- -.----.---- ,. REPAIR/ADDITION (Prev. Sanitation Permit#-------_----------4.' ----.Date-------------------------- . ---------} Septic Tank (Specify Requirementsl-.,--.--.'_'-- -- I_— - Disposal Field (specify Requirements)--------------------'------------------------- ----- ----- .................. ............ . --- ------ ---------- ---------------- Draw existin and re q-wired 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 Ordinances, State Laws, and Rules and Regulations of. the San Joaquin Local Health District, Home owner or licensed agents signature certifies the following: "1 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 becom subject to rkm s Compensation laws of California." .. _. . ..... Owner - '' Signed.... !� Title -------------- ------ -------- ......._.......------- ...... -------------------- - -- -- (If other than owner) l FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY... ........... . DATE DIVISION OF LAND NUMBER._............ ...... DATE._..------ ----- ADDITIONAL COMMENTS....-. ----------- ........................ ... ..... ----------------- -- --------- -- ------- --------- ---......-- ............ ............... ....................... •... - --- ----- ----. _. - ------------------------ ----•--- 3. ..7.x'...... .-... Final Inspection by: ............. ----------Date- --------- ------- - F S 21677 REV, 7/7E 3M EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT