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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT v - -------- '77-(/---- �- '\ --------- ---- (Complete in Triplicate) Permit o.____ __________ �--? Date Issued_--�-_-_----"-_- ............_._..__..___.___-_----___-______--.__ 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: j ------- G -- e .,[ -- ------CENSUS TRACT------ ------------------------- 44 --�� LnJOB ADDRESS/LOCATION-------- -------- -- ,- -Owner's Name------ -- -- cr/qv/ -- -- -------- ------------ . ------------ Phone-_ev ?? /'Address � � - - Y � ----- Zip Contractor'na- me---_.-_- ._��y__: ._ _ -______. ________ _ ________ __License #t /P ----Phone = I . Installation will serve: Residence ( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other---------------------------------------------- 14 cf Number of living units:--/ ____--_-Number of bedrooms-.337----Garbage Grinder-__----------,Lot Size__--- _ Water Supply: Public System and name -------- -------- --------- -- - ------ -------- ----_- -- -__ - ---- ----__ ----__ - -_._ _-Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam $ff 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: (No septic tank or seepage pit permitted if publii�cc sewer is available within 200 feet,) PACKAGEyTREATMENT [ ] SEPTIC TANK [ ] Size___—sl x, _A__Y__I�____________________Liquid Depth---�J_ -----____- Capacity/0h`_'0-------TypePATL_e4Sj *ate-rial--------------------------No. Compartments-------v�--------------- Distance to nearest: - Well---!G`-r _ __ _.______Foundation/e9_____-__-_______-Prop. Line_____�_� ______._ LEACHING LINE K'&. of Lines-_-_7-----------_ _.Length of each line-----7n------------------Total Length -- ---------------- 'D' Box__-/,--..-_Type Filter Material-/AK5t/g__Depth Filter Material-------Il ------ F--------------- 16`V _ -------- ---- --- - -- - - ---- Distance to nearest: Well / -— --._--_--Famdation___ ---------------` Property Line SEEPAGE PIT [ ] Depth_ .---.___-_-_Diameter___---- ----------Number ------------------------ Rock Filled Ye .[] No Water Table Depth------ ---~---------------------------------------------�.Rock S.ize--------- �------------------------------------� Dis)ance to nearest: Well-------------------------------______------Foundation--------------------------Prop. Line-------- --------------- -t, REPAIR/ADDITION (Prev. Sanitation Permit#----'--------------- ------ --------------Date._----..---------------------.---------------_) Septic Tank (Specify Requirements)--------- ------- ---- ----------------------------------•-- -------------------------------------------------------------- -------- Disposal Field (Specify Requirements)--- - --- ------ ------- -------------------------------------------------- --- � - -- - ------ -------- -----------•--------------------= >. ----------------- -----------------------------_------------- _ Draw existing pnd r7quired`additiori on'reverse side) I hereby certify that I have prepared this application and at the wdA will-bw done in accordance'with San Joaquin County Ordinances, State Laws,' and Rules and Regulations ", i�J40t 0 n Co�a1-toHome owner or licensed agents signature c4rtifies the following: "1 certify that in the perfdrmance of the work for which this permit issued;f shnlh not empit'y a person in such manner as to become subject to d ma's; Compensation laws of California." Signed--------- A— Owner ---------------------------------- By------------------------------------------------ - ------------Title------------------ ---------------' -- (If other than owner) FOR DEPARTNTJAE ONLY w*' APPLICATION ACCEPTED 7--�--- --- -- --- - ------ - ----------- --------------------DAT -_ = 7------ DIVISION OF LAND NUMBER- - --------------------------------- - - --- _- ---- - - --------------------PAT -. - -,�--:....�_ ------------------ ADtITIONAL COMMENTS--------------------'-_ ---- ----- --------------------------------------------- -------------------------------------------------------- -------------------------------------------------------- ------- - ---------------------------- ---------------------------------- ----------------- - -----------------------i---------------------------------------------------------- -------------------------------- -- ----- ----- - Final Inspection by:--- ------------------ = Dat ''fit-----------�---7-- - ------------------ EH 13 24 �` SAN J QUIN 0CAL HEALTH DISTRICI�' ", �„ F&5 21677 REV. 7/76 3M