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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No..j -fG? U U Date Issued./.�-,16-.�_� -4 ................... .. 1. ....... .................. 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: c� ----.CENSUS TRACT--------------------- JOB ADDRESS/LOCATION.......-/--�-C ------- ""-..--. 1ll Owner's Name---- ....... _....... _ - ..............Phone .... .7.7_'��-''��-.� Address 7, .`7� .... ... .. . ................... City- Contractor's Zi�pl J� Contractor's Name.......r i.1(.._.131.a.� �. .._ .......---.License License #__y �1.. �---1.._...Phone..? 1� Installation will serve: _ `Residence Q ApartmenFH u ❑ „Commercial ❑.%Trailer Court ❑ Motel ❑ Other... s--=r-- Number of living units:-------3------Number of bedrooms�.-.7_3.. .G�a�r`bci a Grinder---------...Lot Size............................. ........._....- Water Supply: Public System and Home--__: if �.:1N -�---_:_:..-•.................. :..... Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam [] Clay Loam ❑ Hardpan ❑ -Adobe bRf'` 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 Lseptic tank or seepage pit permitted if public sewer is available within 200 feet,l PACKAGE TREATMENT ( } SEPTIC TANK ( } Size .. ..................•-------------------- .............. Depth._._:----------------------Oa Capacity.....................-,Type------- .....--.. Material-.--------- -------- --_No. Compartments------ •.--------------------- Distance to nearest: Well--------------------------------- --......-'Foundation.......... - --•---... ._.Prop. Line..........."-......... ...... LEACHING LINE ( ] No, of Lines- -------------------- Length of each ling_..............__......_...--Total Length .........-,._......_ - ------.Len . ............... 'D' Box------_...-Type Filter Material-._... ........Depth Filter Material----------------------------------- ................. • ..... Distance to nearest: Well------------- --------------Foundation.-----------_-------------Property Line.---•----------------------------- . G rr SEEPAGE PIT [}� Depth..__r .?� Diameter......v�----. ....Number-------------59-------.------- Rock Filled Yes No E]r Water Table Depth-------------•... ..&0---- Rock-Size.......... :.r...----------.---•............. -- � Distance to nearest: Well--------- -----------..........Foundation---- ....._Prop, Line----- ------... � I REPAIR/ADDITION (Rrev..5anitation Permit#----------------------------------------------=----Date.------•-•-........-------.------------------- Septic ------ -----------Septic Tank (Specify Requirements)....'.-.. "--------------------------- r .............:. -----------...-------- 1 Disposal Field (Specify Requirements). --- ----- ----- -------- --- -- ....--- T--------------------------------------------.. ,:: ...... .... ..... .... ..._ (Draw existing and required addition on reverse side)� 1 I 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 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, I shall not employ any person in such manner as to become subject to Workman' Co pensation llaaws�f California." Signed..... �... � ..�/ ``—......... ......dwner Title_... -r (if other than owner) FOR/DEPARTM T USE ONLY `" DATE .....�l- /.� ..�. ------- -------- APPLICATION ACCEPTED BY..'- ---- .- - - �^ •► -�--------- ----- -- ------ DEVISEON OF LAND NUMBER'.. ------------ -------- - -- - ------ = DATE--- ADDITIONAL COMMENTS... �/,�. l�-_.... ----------- --------------------------------- -------_.......... ------------- -- - --------------- -- --- _. � ;..----- -:--- _ -_ • ...:.......... - -- --....._............. `_.F.... ------ ..-- ----- --------------•--•---------------------------..-.-------------- —r ---------------------------•------------------------------------------------------------ ---- - Final-Inspection b ...--_.Date. - .l _"_. . .. ..--- Final ......... ..... EH 13 24 SAN JOAQUIN LOCAL F&5?1677 REV. 7/76 3M HEALTH DISTRICT