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' FOR OFFICE USE: FOR OFFICE USE: APPLICATF�?N F01t SANITATION PERMIT ��!-�33 y _ Permit No..-------•--------..._ r • ----- !Complete in Triplicate} � r/ ._.....I- ....._ 0 --••-•--•------ ---•------- -------- . Date Issued. r ......:........ ............. 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 applicatian is made in compliance,with County Ordinance No, 549 and existing Rules and Regulations: I CENSUS TRACT................ ........ .... JOB ADDRESS/LOCATION. .... S Owner's Name._ .14.x`` ^/7 ------ . Phone ., .. /. Jl p - ---- ---- ------Address...v / .. D.....� Contractor's Name License #_,:_.. .......... Phone. ... .......... •----- _...... -- Installation will serve: Residence� Apartment House E] Commercial ❑ Trailer Court El Motel ❑ Other..... . .. .... . ........... Number of living units:..._-.°-- .. -"-Number of bedrooms.............Garbage Grinder____._.----•Lot Size------- ........._- ......._. t ❑ Water Supply: Public System and name .... Private Character of soil to a depth of 3 feet: tclobeE] and E] Silt El Clay ❑ Peat ❑ Sandy Loam El Cloy Loom ❑ ' Hardpon ❑ Fill Material_. .._. ....if yes, type----------------------- ....... � I buildings, etc. must be placed on reverse side.). W !Plot plan, showing size of lot, locatian�of system in relation to wells, - . NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is avcxi{able within 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK [ ) Size ................. Liquid Depth !) # -...---- :No..Compartments " ------------ ------ Ca acity..--- -- ---- ---.Type---------------- Material.-.-•--- , ii .. Distance to nearest: Well......-......-........ ... --- --------Foundation...... .--- --- -.......Prop, Line-_ ---- ----- - LEACHING LINE E 1 No. of Lines. :_-- :..._ .Length of each lino.- -_ ...Total Length _, ......... ------.......... 'D' Box----- ,Type Filter Material........ ........... Depth Filter Material- ----- --------- --------------- Distance, -•-:-----Distance to n earest: Well--------------- -- -- -----.Foundation------------------------- Property Line---------- ------------ ..... ..._ SEEPAGE PIT [ ) Depth------.. --....Diameter---------------- ---Number----------------- ------------ Rock Filled Yes ❑ No WaterTable Depth--------------------------------- ----------- --•--.Rock Size--- ....._........... ................... Distance to nearest: Well-_._---__._--..------.------- -------"• _Foundati on- - . .... ---- Prop. Line.._---- --- -------- REPAIR/ADDITION {Prev. Sanitation Permit#----------•----- ----_ .... --------Date...... .................. ` -- ---- --. ----- Septic Tank (Specify Requirements) _.' -.-.- ... . Disposal Field {Specify Requirements). "-.---- ----- ' ' . .......... ----------------------------------------- - ----- - {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 County kOrdinances, 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 Yman's ompensation laws of California." { -Owner f Signed_. Title. (If other'thanowner) FOR DEPARTMENT USE ONLY r f -.T.. .... ....... ....... i{ APPLICATION ACCEPT D BY_- , : .- --- -------- ------------------.-D AT E ...... DAT DIVISION OF LAND NUMBER_ ---------- ------- --. -. ....ADDITIONAL COMMENTS. ..__... I I : : __ :: --------------- ---- ...... -- _:: :: ::::::. :::: :::. :::: _:::::::::::--- ..:-:-:.f Final ton by: h : InsPit US 21677 REV. 7/75 3M EH 13 24 SAN J AQUI LOCA HEALTH DISTRI