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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 1 (Complete in Triplicate) Permit No... .:......... 7 -may�y Date Issued�................ •••••.•..•----•............._--_........_.---......_._ 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-----/l?.��.7../.....__-�_�.... �vz � '� ..CENSUS TRACT----•--••--- Owner's Name ._ _. ��yr ......Phone.. ____11�-Z � Z Address-------------- ---- City----- ............ ------- -Zip----------•--------------•---- Contractor's Name-----------._.._ .License #.. lyres.Phone.................... Installation will serve: Residence Apartment House ❑ Commercial F] Trailer Court Fl Motel ❑ Other_... - ------- ------------_------- Number of living units: ----...........Number of bedrooms-"?__ Garbage Grinder............Lot Size............... -___ __ .........:....__----- Water Supply: Public System and name-- ---- ................------- --- _.- ------.Private ❑ Character of soil to a depth of 3 feet: Sand W Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ br; '(� . Hardpan ❑ Ado 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 publicl„sewer is avail le within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK ( ] Size . ...... ��/ ...--------Liquid Depth....................... Capacity----- - - --------Type------- --------------Material--------- --------.-..No. Compartments------------------_- Distance to nearest: Well....------......_.__--.__._ -------..Foundation......... . ...-.._. .. Prop. Line......----...-.._....._...� LEACHING LINE [ j No. of Lines _ ... .....................Length of each line._..........................Total Length .. ------..._._..._-.__.....__.._-_-._ 'D' Box_.-..___Type Filter Material_----- ----- _._Depth Filter Material.........__..__.. .._.........----------------._... ........ Distance to nearest: Well.__...J�-/-,/__._.Foundation.-./_74....------Property Line_--------._7.................. - -------------- SEEPAGE PIT [ ] Depth------ _ ...Diameter_..---.-------_.-..Number_ ______________________________ Rock Filled Yes ❑ No WaterTable Depth-------- -------_------------ ------------ ............Rock Size.----.-------------...--------- ------ ` Distance to nearest: Well--------...........__._______._..._._._Foundation.....____.... ...._...Prop. Line.-___.__....__.._._... REPAIR/ADDITION (Prev. Sanitation Permit#-----._--_..__...-_j--....._..-- ----.---------.Date._..._.-_-.._..-_____._.-__-_ _-------) Septic Tank (Specify Requirements)--- --- --------- --x 3 - - Disposal Field (Specify Requirements) ----- Q.• -----• ------------- ------- ------------I--------------------- --------------------_--_ -------------------- -------- -- ---- ------ ----------- -- C - - ' - - - ----------------------------- (Draw - existing and required addition on reverse sid 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 subject to Workman's Compensation laws of California." Signed _ Owners --------------------- By...... ---�----- --�`-•- -"---- ---�---- -------...-•--...-•- - ---- ---- -.... Title _Tis-�------- ----- -- ...- - --- ----- --- (if 3(if other than owner) 42 FOR DEPARTMENT USE ONLY DATE ..�.�.� _ q.-_ ------ ---- APPLICATION ACCEPTED BY-..--� L�- - - ---------------- - ----- ----- - - - _ - ---- ----------------------- - - - - - - - �f DIVISION OF LAND NUMBER ---------- - DATE.-------- ------ ADDITIONAL COMMENTS- ----------- -----• � -j ---- ------------------------------- - 7 -3��- s --r-'- - ----------•------------ --------•----------------- ---- -- --•--- ------- ---------- - - -------------- ....... -- - - ... --- F1nal Inspection by: - -_ --- .Date. "-2.�.' 7�--- EH 13 24 SAN JOAQ Ill N LOCAL HEALTH DISTRICT F&S 21677 REV. 71W