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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -/.Q ' Permit No...77. . ___. {Complete in Triplicate) Date Issued- -�.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 ith County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION.. . 1JZ�L�E -- _.----- .-.......CENSUS TRACT --------- ------ Owner's --- -Owner's Name_.. ._, ri` L . . �. , iC ��` - ---------- - . - ---....Phone Address.... y�✓ '��F........ ... .... - - _-Clty.,� E'�t<. -�/- .-.:._._..........._ZI Contractor's Name License # .-...: - Phone... Installation will serve; Residence 2� Apartment House ❑ Commercial ❑ Trailer Court ❑ Q„ Motel ❑ Other ...... .... s; S Number of living units:_�....__-__..Number of bedrooms..__.:.. Garbage Grinder....X_ _Lot Size---.. ..../---fXz7_- Water Supply: Public System and name._ _ Private Character of soil to a depth of 3 feet: Sand ❑ Silt E] Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loom ❑ Hardpan ❑ Adobe') Fill Material.. 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 permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ) SEPTIC TANK Size _. ___ Liquid Depth........................ Capacity. /715 ........Type _. ' .._ -.-No. Compartments 2`.-..---- --.----- Distance to nearest: Well..._IOD - Foundation Prop. Line---V`�................. LEACHING LINE ) No. of Lines Z... . ............ Length of each line . ar-- ._-__-___ -. Total Length _70--......... 'D' Box 7j'j'..Type Filter Material ,:..I?a Depth Filter Material.. _-f _ Jf-_ Distance,to nearest: Well-../&r........ Foundation... b. ............ Property...... Pro ert Line_. SEEPAGE PIT [ Depth . '�S I_ Diameter- -3-- --- Number- ---- -- ------------------ Rock Filled YesNo - _ Water Table Depth....90__. .. .......... .._ .. -------Rock Size-"e0— -. ...---.-...---- Distance to nearest: Well _/s O... ...____ ...............Foundation----/t ..._ Prop. Line....__ REPAIR/ADDITION (Prev. Sanitation hermit#............. .........Date.- Septic Tank (Specify Requirements)... ........... . .. ... ................... . .... . Disposal Field (Specify Requirements) _ -----..-. ........... --- ------ --- ---- ----------------- -- -- - ._ - ----- -- --- ----------- ----L--- - ------ ---- (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, I shall not employ any person in such manner as to become sub's to a en's Compensation laws of California." Signed.. �,�_ = _�...... �wne- . BY Title.. (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.. _ .. .. . . .-----� j/1......... ..... ---. _DATE .- '.` - .' -7.-- DIVISION OF LAND NUMBER ... - - -- ------ ---- ------ DATE ...... ADDITIONAL COMMENTS.. ---- ------ - � ..C�-C _ _ -- .,------------------- -- - ------------ Final .----- --- Y. - _ Final Inspection- b Date ....... . ................. EH 13 2A SAN JOAQUIN LOCAL HEALTH DISTRICT 677 REV. 7176 3M