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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------------------------------------- - (Complete in Triplicate) Permit No.77,76-7,6 __�7__.-6.7,6 �_ This Permit Expires 1 Year From Date Issued Date Issued_ __ -7_-�7 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/LOCAT N--_ 37 5----------Li------ ------- - ----------- -- ''---- �et------------ TRACT-------------------------------- Owner's Name- - -- ---- --- ------ -� - ----------------- Phone---------- -------------------------- 7 - cityf--------------- Zip 1 J_i 0------- Address------------ -7 ----- . Contractor's Name ^_ ti�. __� � � . -_ -- ---- ` License # �j'-2-2-4-Phone - Installation will serve: Residence [ Apartment House 0 Commercial ❑ Trailer Court ❑ Motel ❑ Other----------------------------- ---------------- Number of living units:-------l------Number of bedrooms--_-3--Garbage Grinder------------Lot Size--------. �- -____________ Water Supply: Public System and name----------------------------------------------------------------------------------------------------- ---------------Private Character of soil to a depth of 3 feet: Sand E] Silt EJClay E) Peat❑ Sandy Loam 17r.Clay Loam [�''� 4 Hardpan ❑ Adobe ❑ Fill Material------------If yes, type-------------------------------- 1* (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 7seege pit permitted if public sewer is available within 200 feet,)PACKAGE TREATMENT [ ] SEPTIC TANK - Size_ _�/Y__ _C i1'_ __�____________Liquid Depth____________________ Capacity--- ----Type- __-- . _ ___-- ---Material- '>ti-2_-----No. Compartments-----2- ----------------------- f ----------------------,` fes _ Distance to nearest: Well---____________!__d_c�____-__________Foundation______ --------------Prop. Line__S---_____________-_ LEACHING LINE [ No. of Lines--------- .. g _ /_____-.Total Length _____/-r_�� _______________ ______________Len Length of each line.________7_ _____ _____ _____Type Filter Material_______ '__ ___ Depth Filter Material--------��_.--_.____________________________________________ 'D' Box____ _ ,S u.M 10 Distance to nearest: Well__________J_D ._----_.Foundation-.----- :C'__�_._..._,___Property Line______S_-_________________---_ �E€ -PiT (�'J/ Depth _ 3_-__B+ameter_ �__X_]1-_Number_____ �. ___1 Rock Filled Yes No p i---- Water Table Depth-------------- - t"-------------------------------Rock Size----1 1p- X 3--------------------- Distance to nearest: WelL.__________ z (?_ ,___!'"' --------------Foundation------I_0_1-1-------- Prop. Line----�i-t----------- REPAIR/ADDITION (Prev. Sanitation Permit#________________________:_________.______._____.Date.-_------------------------------------------- Septic _________ -----------------Septic Tank (Specify Requirements)------------ ------------------------------------------------------------------------------------------------------------------------------------- Disposal Field(Specify Requirements)--------------- ------ -------------------------------------------------------------------------=-==---------- --------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ (Draw existing and required addition on reverse side) 1 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 subject to Workm Compensation laws of California." Signed------------------------------ --- --- Owner - --- --- - ` - - `- 1, BY a - -- 'U------------------ ------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- - - ------------------------------------------------------------------DAT E.__glG ? ?----------------------- DIVISION OF LAND NUMBER---------------- ------------------ ----------------------------------------------------------------------DATE ------------------------------ ------ ADDITIONAL COMMENTS-------_-------------------------------------------•--------- ------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------- - --------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------- ----- � ------------------------------ -------- --------- ----------------Date------------ --- Final Inspection bY:------- �� L ------------------ EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M.