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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT G ----- ----------------- - Permit No.--7�=_'S�./ (Complete in Triplicate) ---------- ---------- - ------- qq - Date Issued._7_�1/7,P ----------------------- ------_ - --- 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: JOB ADDRESS/LOCATION --------- �Z ------------------------------------------------CENSUS TRACT_------------------------------ Owner's Name-- --; - -- -------------- Phoney-f?y ------------ Address Q_` l lr / City-.,.,�¢ ,.G Zip ---- -- - ----------- Contractor's Name------------- ---------- _-J 4Q/_----------------------License # �'1�=3 3---- Phot►e__` +_��G'�--- Installation will serve: Residence Apartment House El Commercial ❑ Trailer Court E] Motel ❑ Other--------------------------- ---------------- Number of living units:_ __f______-Number of bedrooms------------Garbage Grinder------------Lot SizeA,?,,�' _J*3------------.----------------- Water Supply: Public System cr"nd name------------------ ---------------- ---------------------------------------------------------------------------------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 wells, buildings, etc. must be placed on reverse side.) C- NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ Size_-________ _�n_h-_�__.____________________Liquid Depth _- .N __- Capacity2YUQ_______-Type__ _______-Mate�rlal__-c�'�_____No. Compartments-_-___�-_____________________ Distance to nearest: Well-__-_-_-fes _____________________Foundation_-_-'_L_C2_`________-Prop. Line��_-�-_____-_---_-.s LEACHING LINEI--- � � - pQ No. of Lines___________ _-___-__.Length of line.-______-!__�-_- __-___-.Total Length.__��-______-__--_-______-____ 'D' Box--___Il__T e Filter Matert_Q9 � _ A-,"'-.-Type ial____ _.Depth Filter Material __/_1?11__ Distance to nearest: Well------/4?_"F''_-__._Foundation----- -------------Property Line 0-----------------------` SEEPAGE PIT. D4 Depth _95__-,-Diameter_:__ ,6k�•_-_-_-Number----------- --__ ____________ Rock Filled Yes K No ❑ Water Table Depth- -.---------------------------------------------------Roc k Size..--/`a`-...X O�- --- --------------- Distance to nearest: Well Qa _:t7 _Foundation------ IProp. Line-Jr-14- REPAIR/ADDITION (Prev. Sanitation Permit#---_-_____.---------------------.___-_-__________-Date-___-__________-______-__-___________-) Septic Tank-(Specify Requirements)__ ----------------------------------------. --- Disposal Field (Specify Requirements)------------ ------ ---------------------------------------------------------------------------------- ---------------------------------- -------------------------- �.._'-c.*.— �Z--------------------- ---------------------------------------------------------------- ' (Draw existing and required addition on reverse side) I hereby certify that I have prepq'ed this,application and_that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Ryles and Regulations of the San Joaquin Local Health District. Home owner` or licensed agents signature certifies-the following- "I ollowing"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 laws of California." Signed----------------- --------- --------------------------------Title' _ Owner ----- ------BY - o er than owner) FO DEPART NT 4 ONLY APPLICATION ACCEPTED BY- - ------------------ ----------- -----DATE --------- DIVISION OF LAND NUMBER.-- -- ----- ---- - - ------------- ---------------------------------_-_----------- - DATE---------- - -----------------I------------- ADDITIONAL COMMENTS_--------------------- -------------------------------------------------------------------------------------------------------------- ------------------------------ - -- - ----------�-0"a'1---- 4`�`�'' - - --------------- ---------------------------------------------- Fi-n-a I --- - ---- ---------------------------- FinalInspection by: - ------------------------------------------------------------------------------------------Date-----1D� ' , --------------------- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 REV. 7/76 3M