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FOR OFFICE USE: '7 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------- ----------------------------------------- (Complete in Triplicate) Permit No..7$'-.��_a` ------ - -- ......... ll...I_------_--_------ _ This Permit Expires 1 Year From Date Issued Date 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.--._ __ - ----'---------------------------------------------------------- ( _.,_. :._._.?.._.CENSUS / ) te TRACT_ . Owner's Name--------L ------------Phone --------------------- .. . .. .f..._.i...�-.r. ,City - .,. Zip- .. - Address S �Contractor s Name--'-- hone--- ------------------------- A-Itl Installation will serve: Residence [Apartment House ❑ Commercial ❑ iTrailer Court. ❑ f Motel [� Other--= --- ' -- ---- „ -- of,living units:_:____-___.__Nurnber..of. bedrooms;__„�.__Garbage Grinder--#Y-- ,.Lat;Size---=__ -- -------l t..-- ----------------= ----- NumberT' Water Supply: Public System and name------ ` - _•.= - -.--.--.- ------Private [�S Character of soil to a depth of 3 feet: # SdAd Silt❑ Clay ❑ Peat ' ! Sandy Coam ❑ Clay Loam ❑ Hardpan —Adob`e E]�Fill`Maierial_�1fyes,'ty`pe-- - (Plot plan, showing size of lot, location of:system in relation to wells,'buildings,�etc, must be placed on reverse side.) �J NEW INSTALLATION: (No'septic tank-.or�see ge pit -permitted if public sewer is available within 200 feet,) ..! [ i Size_ � �� ViaLiquid Depth ___________'E TREATMENT tSEPTIC TANK" [PACKAGf_ _ r Capacity__[- `�`'-F�____._Type -- ----•------ __Matarial- ' �^-��' No. Compartments- ----- -------------- 1 ?� f; S l 4 i rR 1 t _ = l --Prop. Line--- ----------------- Distance,to_nearest:.Well - ____ _. _-t_,.__Foundation LEACHING LINE: [ No, ofiLmes_'.________:3..___.______.Le`ngth of each lin'e..,.____ --__�'.-__ , Total Length ------}__. D' Boz -1 I D`,e th Filter Mater -- _. _Type Fi-Iter Material � _.�=�_. p �_�____ Distance:to nearest: Wei ------ Foundation.___ _! -_- Property Line --- _ € � � i .:.. -- ., :.�-._ .. �_,..._..�...- ; ,.. o. rya •* SEEPAGE PIT [ ] Dept------------------ a I ice_. Water Table'Depth---=--------- - --------------------. Rock Size- ' , Wel } �. . .�.—., Foundation = .Prop. Ling e----- -------------- Distanceto nearest:' _ =— REPAIR/ADDITION-�(Prev SaAitation P'ermi't#------------------ ----------------- ----°-:Date----.- ---------------------------[ Septic Tank.(Specify Requirements)------ -------- - ------------- '--- `=-------------------------------------- -------------- Dis asal Field (Specify Re uirements) _ ----------------- ----------- ---- --------------=------=---------------- --------------;-- -------------- ---- -------------------------------- -- --- ---- ----- -------=--- ------ -- - ------ -- - - ------ ---- ----- ---- -- --------------- ----- ------- ---- -------- ----- ---------------------- ----------- ------------- ----- ----- - -- --- - - ------_---- ---- =- --- -- -- (D'aw existing and required addit'ian on reverse side) hereby certify-that'l 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 ther San Joaquin Local Health District, Home owner or licensed agents signature certifies the following: I "I certify that in the performance of;t -'.work-'for which this permit is issued, t-shall not employ any person in such rtianner as to become subject to Workman's or" sation: laws of California." F Signed-------- r :Owner : I�A BY Title. Y � (If other than owner) F. FOR' EPARTMENT'USE ONLY . . _ _ .APPLICATION ACCEPTED SY .___ --..-= ---- l[I -------. :. --------------- DATE.--- � !` ----------------- DIVISION OF LAND NUMBER--------------- ---- ' --------------- -- - = :.---------- ------------------DATE--:--- ---- - •-. ADDITIONAL COMMENTS. - ------ - -- - - ---•----- -------------------------- ----- ----- --- --- -------- ----------- ---- - - --- ----- --- ------------------ ---------- ----- -------------=----------- ------------------------------------------------- ----- " Inspection _ .--_ �- Date. - ------ Final � b ------------- - --- �_ _ -- --- ------------------------- ----------= ------------- � � �---='---------------- - - Y� --- EH 13 24SAN JOAQUIN LOCAL HEALTH DISTRICT F&$21677 REV. 7/7b 3M