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FOR OFFICE USE, FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - -------------------------------- --------------- (Complete in Triplicate) Permit o._-_77______7 --6._--.7/--- --------------- -- - -- -------------------- Date Issued.- '-l;_ 7 2 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 describe This applicatio is mad in comp nce� # ounty Ordinance No. 549 and existing Rules and Regulations- AA egulations: JOB ADDRESS/La5ATIO - - --- ,d/�4' FCNSUS TRACT. ------------------------------------------Phone------ ------ --- -------------- Owners Name.----------------- --�f-- - �, C1l Address-------- L 3 =---------- - - --- ---- -- - ----------- GitY `" ----------------------------Zip---- ------ ---- Contractor's Name.-- -c.- _, Q__ --_ _- ense Phone----449 ti 960 7-,Z Installation will serve: Residence Apartment House.❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other---------------------- ------ ---------------- Number -- ----------------- Number of living units------- --------Number of bedrooms,.----Garbage Grinder------------Lot Size----17-.-----..--..-.----_-_--.--_.----.----..,-. Water Supply: Public System and name_--------------- ---------------------- "-------- ----- ------- --------------------Private Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat❑ Sandy Loam ❑ 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: 7 (No septic tank or seepage pit permitted if public s wer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANKSize.--_ ..-,- -- -- ------------------------------Liquid Depth-_ _- Capacityjo1 ---------Type-----------------------Material--------------------------No. Compartments------------------------------------ Distance to nearest: Well - � -------------------------Foundation Line.-' ----.---:. ... � f LEACHING LINENo. of Lines___________________Length of eac line..-- --- ---------------- Length--------_-�- _______-_f,_ 'D' Box---)_- .-_Type Filter Material--. p �� De th Filter aterial Ze --- -- QDistance t0 nearest: Wei l �.---_':-._- oundation__-_ -____Property Line.--------- ------------------- SEEPAGE ---- ---- SEEPAGE PIT De th�C�--Diameter.- p ��.------Number--_--- ---------------- ---- . Rock Filled Yes No Water Table Depth � � Rock Size --------- \ Distance to nearest: Well_-.- -- --------------------Foundatior/77--._--_____.Prop, Line_______-_� ------- V REPAIR/ADDITION (Prev. Sanitation Permit#-------------------------------------- -__.Date___-______-.-___-_------------.--------------- SepticTank (Specify Requirements)--------------------------------------------------------------------------------------------------------------------------------------------- Disposal Field (Specify Requirements)---------------------- ----- -- ------------------------------- I- ----------------- ----- -- , ------------------------------------------------------------------------------I------------ _-- = - -------------------------------- - -------- ------------------------------------------------- - - -------------------- - - --- --------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Cou Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agen signature certifies the following: "I certify that in the ormance of the work for which this permit is issued, I shall not employ any person in such manner s to becomes biect t orkman's Co nsaticm ws of California." Signed------ -- -v-- -,- -- - --- -- -- By------- ------------ --- ----- ------------------------------------------ - - -- - -----Title----- --------- (If other than owner FOR jDEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ -- `'`"`_ ------------------------------DATE.------. ../7 -7 DIVISION OF LAND NUMBER_______________________ _ ------------------------------DATE---------------------- ADDITIONAL COMMENTS---- --------------------------------------=-------------------------------------------------------------------------------------------------- --------- _ ____ _____ ____ --------------------------------------------------- ----------------------------- =_1 ------- - _ _ -------- _ - _ _ - ----------------------------------------------------- Final Inspection by------------------- - D .--- ---------- ------------------------- ----- ----------------- ---- ate---- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M J