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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------- (Complete in Triplicate) Permit No._7_- _'�_______ ------------------------ Date Issued___ v--------------------- -------- --------------- 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 Co trOrdinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATI N ;? ° - ---------CENSUS TRACT------------------------------ Owner's Name------ ---Phone --- ---- _ --- ----- -Zi Zip ------------------------------ Address �� _----_ _ - -._ Cit Contractor's Name______ y� -__ � Installation will serve: Residence Apartment House.❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other-------- ----- ----- _ ---------- Number of living units:-____/-----Number of bedrooms__-2---Garbage Grinder------------Lot Size___-! - ! --x laS-------------------- Water Supply: Public System and name-------------(VGds-----64) -�-----------------------------------------------------------------------_Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material------------If yes,type-------------------------------- (Plot plan, showing size of lot, location of system in relation to w-etls, 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,) ,�f PACKAGE TREATMENT [ ] SEPTIC TANK D Size__'f �( ? _ _____________________________Liquid Depth._-7--_-________-______ '� _ � Capacity_j,Aep---Type ----- -------Material___ _No. Compartments------- --------------- ------ Distance to nearest: Well --_---/2 _____________Foundation_____`Q__f______-Prop. Line--- -------------- _. LEACHING LINE No. of Lines--------/------------------.Length of each line--- �� _Total Length ____-____- _,�__________ 'D' Box------------Type Filter Material__a`'__.t-/I4CP.Depth Filter Material________ _____________________f._ 01 3 Distance to nearest: Well- �-------Foundatioon-----/d----------------Property Line----�---------------------- SEEPAGE PIT Depth_,_ __.Diameter--- ---------Number--------!__-------------------- - �� Rock Filled Yes " No Water Table Depth_______-F.j____________________________________.Rock Size-- - -------------------------------- < , Distance to nearest: Well---------w/ - ----------- foundation----fly--s-----------Prop. Line__, -- REPAIR/ADDITION (Prev. Sanitation Permit#_________________________.______________________-Date_---____-_______._____-_.________-____-___) SepticTank (Specify Requirements)--------------------------- -------------------------------------------------------- ---------------------------------- --------- DisposalField(Specify Requirements)-------------- ------- ---------------------------------------------------------------------------------------------------------------------------- ---- - ------------ (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 becomeub' to Work m Commensation laws of California." Signed------ T ' - Owner By--------------- - -------------------- • - -- --- �- -- Title---- (If oth than ow er) DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- -- --------- --- -----------------------------------------------------------------------------DATE__/--_��=% DIVISION OF LAND NUMBER--- --- -- -- -- -------------------------------- --------------DATE------ ---- -- -------------------------- ADDITIONALCOMMENTS----- --- ----------- -- ----- ------ ----------------------------------------------------------------------------------------------------- ------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------ ----- --- FinalInspection by - 1/`'�- --- ----------------------------------------------- --------------------------------------------Date--------- 7 - EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT FF&&S-21677 REV. 7/76 3M