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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -7-2_�7G ----------------------- --------- --------_-------- ---- Permit No.------- ----------- . (Complete in Triplicate) ---------------- ------------- . % Date Issued- . -----/------d"717 ---------- 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.ajn�d existing Rules and Regulations: / �i-6!/1. , -aG •--CENSUS TRACT---------------------- ----- JOB ADDRESS/LO TION---_--�/1�-------- - --- hone------------- ---- Owner's Name. ----- P ` / Zi -------------- -- Address ll-v�•c-----� ---- City P //�� Contractor's Name-.-_ -- -- f ¢ License #_ _?l c 7 Phone__ _ -- ---------------- Installation ! GInstallation will serve: Residence Apartment House❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other--------------------------- ---------=------- , Number of living units:-----l-.-------Number of bedrooms_/-3---�rba e Grinder_---------.-Lot Size__._.---XvyQ--- -------------------- ---- Water Supply: Public System and name---------------0u.- - ---____----_.----------------Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ' Fill Material-----------.lf yes, type-------------------------------- (Plot ------- ------------------(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 permitted if public sewer is available within 200 feet,) y PACKAGE TREATMENT [ ] SEPTIC TANK ( �e,,Siiz�e---`-_� a X- ----------------------- -_____Liquid Qepth.______._._______._-___r Capacity-I A.0-a-------TYPepw- `-"'`�'r----Material -----------No. Compartments- ------A-------------------- A 01 Distance to nearest: Well---- ------------==----Foundation-..=./®-----------_-=.Prop: Line-----*�------- -------- LEACHING LINE No. of Lines------ ------------------Length of each line._ ®_` yU= - „9 y --- �-- - .Total Len th.-- ��------------------------ � 'D' Box-.-/-----Type Filter Material_S_,R4c*-Depth Filter Material---__/416-------------------------I---------------------- Distance to nearest: Well___,NQN_F-----------Foundation__-o24___----------------Property Line....---- -------------------------- SEEPAGE PIT Depth---�__...Diameter-__33-----------Number---_ ------------------------- Rock Filled Yesv No [] i Water Table Depth Rock Size----� -- -------- ------------------- ---- P i Distance to nearest: Well----------- ----------------Foundation-__-A0__---____.-- Prop. Line_---5___--_-_-_-_------+ REPAIR/ADDITION (Prev. Sanitation•Permit#------------------------------------------- ------Date------;------------T-------------------------1 Septic Tank (Specify Requirements)- ---------------------------------------------------------- --------------- ------------------- ------------- -- ----------------------- � s) Disposal Field (Specify Requirement ------------------------------------------------------------- - ----------------------------------------------------------------- --- (Draw existing and required 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: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become ble t toTWman' Compensation taws of California." Signed �- ^ �- Owner ----- Title ,---------- ----------------- -------------------------- (if othErr than owner) FOR DEPARTMENT USE ONLY - �- ---------- ---DATE - __"-�a_"_�7_____ ----------------- APPLICATION ACCEPTED BY--------- -- -- DIVISIONOF LAND NUMBER---------------------------- ----------------------------DATE---- ------- ----------------------------------- ADDITIONAL COMMENTS-------------------- --------------- -------------- - ---- ----------------- ------------------------------------------------------------------------- ---------------------------------------------------------- - ' - P --- ----- ------- --- ---- ------- ---- -----------------------6 -- --- - ------------ Final Inspection b Date ------- ----- ----- ---------- P Y;------- ------------------------ - EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT f&5 21677 REV. 7/76 3M