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FOR OFFICE USE: -USE:" APPLICATION FOR SANITATION PERMIT ------------- _. * (Complete in Triplicate) Permit No..7 _"._- --•-- --....._ ...-. -- Date Issued,,.. n.,7./-? --•...........................................:...... This Permit Expires ] Year From Date Issued Application is hereby made to.f'•he 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...-Yoo........ . -CENSUS TRACT-------------------` ---- -- Owner's Name Phone.. r Cont acto.'s Name _. Llce ZiP nseJ`7�.�1l/ Phoneg f Installation will serve: ` Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ di Motel E] Other_ 7,n--GiC�•�--- Number of living units:. ..........]-_-Number of bedrooms..?j.......Garbage Grinder-.----------Lot Size----L .o _. .. - ; Water Supply: Public System and name.- . --------- --- --- = ---------------------- ---------Private Character of soil to a depth of J feet: Sand-E.] Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam -' Hardpan ❑ Adobe❑ Fill Material _ - _ If yes, type-------------------------- - - Mot plan, showing size of let, 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 .-�.............. .:� .. . ^n.. L -.-No. Compartments _Ca acity OGTYPe Material _ id Distance to nearest: Well_-4.10.,��..... .....................Foundation..__,.. . ------ -- - Prop. Line LEACHING LINE [ ] No. of-Lines ....1;Z1-----------......Length of each ]in&.....57_�?------------ -,_ Total Length -1.7P-------- 'D' Box- Type Filter Material--- J ...Depth Filter Material.-.-`-_ -_.---.._...- ------ ---- -------- - N C e Distance o nearest: Well---`._ij�.............. Foundation---•.-----------------------Property Line--------------------- ...... -......--- SEEPAGE PIT ( ] Depth.;;. . ...._Diameter. -3------------.Number_...... 6k------------- Rock Filled „Yes No Water iTable Depth.----•--------------------------------.- .....------Rock Size Js. .....-- ----------•-- ------- 1 Distance to nearest: Well.-.---------------_ ------------- - Foundation------ ........ .........Prop. Line............------ ---- r REPAIR/ADDITION (Prev. Sanitation Permit#------------------ - .............Date....---.:.--------._..:.-----------_-----_....) r Septic Tank (Specify Requirements)--------- --- - ----- -- Disposal Field (Specify Requirem . ents)..................--- .._ - ---------- ..... -- ................ _._... ---- --- -------------- ................. -` --------- .......... --- ---------------------- -----------._....---, ........... x (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: r "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 Compensation Idws of California." ' Si ned h - - --- ----•:- ---- Owner f g 3 ----- By------- f e ..--- - . ... . ....--- (If o her than owner} -- ? FOR'DEPAR MENT USE ONLY rt Q.. . APPLICATION ACCEPTED BY--.i,.. 3_ .......DATE7i7 7..� ;...DlVISlON OF LAND NUMBER. ..r _-„- DATE..... ---------------- ---------- ADDITIONAL COMMENTS:. - ............. .:..^;..;_.. ....:..._. ..._ -.+` .... .... ................ .. _ --------- -•-------_--------------'----._ .. .. --_ ... -._.__ _- ------'-- -- ----- . .... .. .. -. .-. - ` - -- ....: ... ... ........ ----- :._.-_. .-Date. Z �� ... Final Inspection by:......-- -Cn. . . . Fes 2577 REV. 7/76 3M EH 19 24 SAN JOAQUIN LOCAL HEALTH DISTRICT ti