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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------------------------- 87 (Complete in Triplicate) Permit o_ _-_____---------------- --- - ---------------------- �a -------------------- This Permit Expires 1 Year From Date Issued Date Issued ______.____________- Application is hereby made to the Son 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 _ ___ '' _ __'C_--__-- '1___P _* __AaA---- ----�CENSUS TRACT --------------------------- Owner's Name �yf •- .� 'Z -•----------------------------- ----------Phone ------------------------------------ Address ----- `,� f �� l .- !' ----------------------------- City ----� r Contractor's Name - ---------------------------------------------------------=-------License # ---------.-- ------- Phone ----------------------------- Installation will serve: Residence ❑ Apartment House-E] Commercial :❑Trailer•Court Al Motel ❑ Other ----- ---------------------------------- Number of living units:__________ Number of bedrooms ______Garbage Grinder ------------ Lot Size _ _ _ _ ____________------------ Water __________Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private-E] Character of soil to a depth of 3 feet: Sand'❑ Silt:❑ Clay ❑ Peat ❑ Sandy Loam ,E] Clay Loam E] 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 204 feet,) PACKAGE TREATMENT SEPTIC TANK Size-- `�' �__ `_. [ 7 p►'] --------------------- Liquid Depth ......... .. Capacity 1,2—AP---- Type)!? -_'r��__--T* Material__t��f1aj_.E—__.___ No. Compartments ____ ----------- Distance to nearest: Well ----/4_q___ ____._.--.___Foundation _10_____________ Prop. Line'- ................. LEACHING LINE. ] No. of Lines _____ _____________ Length of each line_______ _____. ------ Total Length /_�_________________ 'D' Box �- --_ Type Filter Material - ...)�-1%_.____Depth Filter Material .......... ,Distance to nearest: Well ___Zf_�_A___ Foundation __. __� �b --------- Property Line --�- ---------•----• SEEPAGE PET ] Depth __ _ _ ,____ Diameter ______ --- --- Number ---------------------------- Filled Yeses No i❑ Water Table Depth ----- d---------------------------------Rock Size ----/.` -7--------------- J. e, Distance to nearest: Well _ !I©------k____________________Foundation --1d �_____. Prop. Line ... .. ......... REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ----------------------------------) 9 SepticTank (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. Son Joaquin local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to becon �sJub)ecr to Work an's Compensation laws of California." Signed --- JrCC �� M1 --------------------------------- Owner By ------ -------- Title ---------------------- ------------------------------ ----- ------------ - - - - - - - - --------------------- --------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY a ---------------------------------------- ----------------- DATE 777!11 PERMIT .ISSUED ---------------------------------------------- -----------------------------------------------------------DATE ------------------------------- ---------- ADDITIONALCOMMENTS ------------------------------------------------------------------------------------------------- = --------------------------------------------------------- ------------------------------------------------------------------------------------------ -------------------------- -------------------------- --------------------------------------------- ------------'--------------------------------------------------------------------- Inspection b ----- r' Final Ins � � . p Y t ------ -----------------------------Date -r.��-- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT [ E. H. 9 1-'6$ Rev. 5M `i`''