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FOR OFFICE USE: FOR OFFICE USE; <br /> APPLICATION FOR SANITATION PERMIT <br /> -.... . .................... <br /> (Complete in Triplicate) Permit No. .. <br /> ......---••--•------------- ----------- -�---...._..----- Issued.,/.�.�g:,7� <br /> ....................•• -•--- ............ ...... This Permit Expires 1 Year From Date Issued Data <br /> ,f <br /> Application is hereby made to.the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance withrCounty Ordinance No. 549 and existing Rules and Regulations: <br /> JOB <br /> AddreAsDs.D.RESS/L . TION <br /> ION.... ._. - -- ... N- e . . <br /> -- ----------.-.--.-.-.- ------- --•- --- NG.= <br /> .._cc.,_2.. <br /> .�..... - <br /> Owner's Name.-- N. -----------------.. - ---..... <br /> Phone.---- W <br /> -. -------- CA Jzip .A-� a .C. <br /> Contractor's Name--..... # .{-.-.-.- <br /> ...... f <br /> Installation will serve: Residence`] Apartment House ❑ Commercial ❑ Trailer Court �] <br /> Motel ❑ Other-- . . ---- -------------- -- <br /> Number of living units:....... --------Number oedro s....�__...Garbage Grinder.. ...Lot Size................. <br /> � <br /> Water Supply: Public System and name....... _ . .. <br /> -- .Private JO <br /> Character of soil to a depth of 3 feet: _ Sand.v Sift❑ Clay ❑ Peat ❑ . Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material.. .... ....If yes, type.. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK Size----- - --- - -------------------------- ------Liquid Depth...::. .................{/i , <br /> � <br /> - <br /> Capacity - - --- -----TYp? ------------- -----Material---------------------.----No.' Compartments.................__--....--- y <br /> Distance to nearest: Well----------___.................. -_-._...Foundation.._..°'... . .............Prop. Line....................... . . <br /> LEACHING LINE [ ] No. of Lines-----------------------------Length of each line........................ Total Length _. -.----.-----------------..-.------..C4 <br /> 'D' Box............Type Filter Material........ ...........Depth Filter Material.......-.............-------------------------------------------- <br /> � � <br /> SEEPAGE PIT Distance to nearest: Well......_................... Foundation----------------------- .Property Line...............--................. <br /> j ] Depth................Dia meter-------------------.Number-------------------------------- Rock Filled Yes ❑ No7 <br /> P ' <br /> Water Table Depth--------------------------- ------------_------•------Rock Size--.--.--- - ---- ---------- ---- <br /> Distance to nearest: Well...----------------.........................Foundation...................-......Prop. Line......- ---.-- -.- . - -• <br /> REPAIR/ADDITION (Prev. Sanitation Permit#----------------................... ."-------------Date----------------.................-------..-----) <br /> Septic Tank (Specify Requirements)------ -------------------- ------ ---- /f (' 1 = <br /> Disposal Field (S ecify Requirements) 1� l ��Il hs �Sli.�r/.... c.w , / _.._ �s/ /�� J��l. c' � ���-----_-------------- <br /> _,....pEi / \a.cl.. <br /> {Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin .Local Health District, Home.,owner or licensed agents <br /> signature certifies the following. <br /> "I certify tha n the p rfo a ce of the work for which this permit is-issued, I shall not employ any person in such manner as <br /> to become su r s Compensation laws of California." <br /> - ---- --------------­ <br /> Signed_ _. <br /> Owner ;. 1 <br /> BY-•----•-- -------------------- ............................... . . ................................... <br /> (If other than owner) <br /> FOR EPA "MENT US"NLYZ <br /> APPLICATION ACCEPTED BY °�., DATE �"ry ................ <br /> DIVISION OF LAND NUMBER....................... DATE-------------------- <br /> ADDITIONAL COMMENTS... - Y -------------•---------._ r.... <br /> Ca „� -� "" ............. ------.---- <br /> --------- ---- --------- ------------------------------------------- --------------------------- <br /> -�- <br /> -----------•--•--•--•-- .....................- - -- �................... ------ ---- -- ---- <br /> Final Inspection by;---- ---- "'.".�`--------- 3"`�`3.�1r <br /> Date.... <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 RFV" 7/76 3M <br />