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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------------ --------------------- (Complete in Triplicate) Permit No._7-7-"':_ 7�' ---------------- - - - - - L' Date Issued__,41:_.'�__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 with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION------------------� ' A-U ----- ------------------------CENSUS TRACT--------------------------------- Owner's Name--------74-------Q s-13_Ct R/t?46F------------------ ------ ------------------------------------------------------ Phone.. �`i%3 - ---------------------- Address----------------------------------------------------------------- - ---------------------------------------city ^,4,41Af?W4:7'�--------------Zi - Contractor's Name----1.4.-- L..1- -----------------------------------------------License #_j;AA5-6Br .---Phone_ Installation will serve: Residence X Apartment House❑ Commercial ❑ Trailer Court ❑ / Motel F] Other----------------------------- ---------------- /-O-Ac- Number of living units:__--I--.------Number of bedrooms _______Garbage Grinder------------Lot Size-___________________ _____________________ ----------------- Water Supply: Public System and name----------------- ----------- -------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3Te`et`: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam P 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200jeet,) PACKAGE TREATMENT [ J SEPTIC TANK [ J Size________________________________________{_ ---------Liquid Depth-______-______________-__ Capacity------------ --------TYPe-----------------------Material-------------------------t4o. Co'MR9rtments----------------------------------- Distance to nearest: Well-------------------------------------------:Foundation__ .--------------------Prop. Line____________-.______.___. LEACHING LINE [ ] No. of Lines-----------------------------Length of each line.------------------------------Total Length._,-__________________________----_-_-_ 'D' Box------------Type Filter Mater+al-------.----------Depth Filter Materiae------------------- ----------------------------------------- Distance .------------ ---------------.Distance to nearest: Welt-=-------- ---- --'"`-_Foundffiio -----------.`__'_ ,- __ ___Property-L,ine _________ SEEPAGE PIT [ ] Depth _______--__ ---------------Number-------------------------____ Rock Filled Yes ❑ No ❑ Water Table Depth"-- ----- --------• :.f ock Siz --------------- ------r;---------------------- Distance to nearest: Welt----------------------------- Foundation_'_?--_-__-___-___-__Prop. Line--------------------------- REPAIR/ADDITION --_______-_-________--___REPAIR ADDITION Prev. Sanitation Permit#-- ---__ ---.-- Septic Tank (Specify Requirements)---------. ____ - Disposal r ' Field (Specify Requirements). . ! , ___ -------' -------------------------------------------------------------------- ------------------------ - (Draw existing and require3-adcdttion on reverse side) 1 hereby certify that I have AreuyT area tl+is application and that the work wip 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 A shall riot employ any person in such manner as to become subject o Workman's Compensation laws of California." --------------- Signed--- ----------------------------Owner By--------- ----------------------------•----------------'----------- ------- ------ ----------------------Title---------- ------------- ------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. - - DATE - 11 ---2--7------------ DIVISION OF LAND NUMBER---------- _ _ DATE_-________________ ADDITIONALCOMMENTS------------------------------------ ------------------------------------------------------------'--------------------------------- ----------- --------------------- -------------------------------------------- ------- ------ ----------------------------------------------- ----- ------------------------------------------------- ------------------------------------------------------ -------------- --------------------------------------------------- - --------- ------------------------- -------------------------------------------- ------------ Z - - -- ---- --------------------- Final Inspection by:----------------------------- ---Date- --�� EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fas 21677 REV. 7/76 3M