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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � 2 {Complete in Triplicatel Permit No !. ......... . ...... Date Issued- -/r .-7.� ••-•-•••.....................---....-- ------------------ This Permit Expires 1 Year From Date Issued Application is hereby made to.the San Joaquin Local Health District for a 'permit to construct arid install the work herein described. This application is made in compliance-with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -.• --1 V��........ ------..CENSUS TRACT------------------ ------------- Owner's Name 9 --------------------------------•- Phone.... ------- Z Address..l.r .91 .... -- _.City------:-------------------_ .--....--Zip------ Contractor's Name..... ..' -� license #. - 1 ....Phone ,;310.4 Installation will serve: Residence Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other.......- --- - --------------------- ¢3 -.� f�. Number of living units------ _ -.----.--Number of bedrooms 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 [] Cloy Loam ❑ t Hardpan ❑ Adobe❑ Fill Material.. .... ....If yes, type.............. ..--......... (Plot plan, showing size of lot, loco tion of system in relation to wells, buildings, etc. must be placed on reverse side.) 09 M NEW INSTALLATION: (No 'septic tank or seepage pit permitted if public sewer is available within 200 feet,) s• V PACKAGE TREATMENT [ ] SEPTIC TANK ( ] Size... ----------------------Liquid Depth---- - Capacity/.�p Q.0--------Type---.J....... ......Material_..- I-----------No. Compartments-------17,----------- Distance to nearest: Well-:.-.-...piss ..-_.....Foundation_!_0 O. .......... ..Prop. Line--- '..------._......-.._ r LEACHING LINE [ ] No. of Lines __.9il�.-------------------Length of each line---- ^------_Total Length _ ........ 'D' Box....f ...Type Filter Material..-._. Depth Filter Material._..._../.. rr .----- DistanZ to n'� t: Well...-. ..Foundation........f?..p--.........Property Line...Ei-.:-----. S9441AGE PIT ( j De th- �t�r------------- ---- p -- Number-.----- -------------------- Rock Filler! Yes No❑ i Water. Table Depth..-----•--------•------_-- . - Rock Size.- x� ` �7 .- ------------------------ ! Distance to nearest: Well...... --.- - - -- Foundation-._.�W..... ...--.Prop. Line_------------------- REPAIR/ADDITION {Prey. Sanitation Permit#---- ------ --------------- ----- ---------------Date------------------------------- --------------1 Septic Tank (Specify Requirements)................... ..............-------- Disposal Field (Specify Requirements)----.__._............ ------------ --------•--•- --- - ------ --------------•-------------- --- ---- ------ ---..---------- --------------------------------------- _.............. .........- ---------------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 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's Compensation laws of California." Signed-----..... --- - - Owner .. Title.-..-... --- -------- By other than owner) FOR PEPAgTMENT USE ONLY APPLICATION ACCEPTED BY--------... . ......... ........... ------------------ -DATE ---------- DIVISIONOF LAND NUMBER........_-- /7_7 ------------- --- -- ------------------- -----------------------------------DATE -------- ---_--------.._._ __ -- -- ---- i ADDITIONAL COMMENTS.......... ....... -------------------------- . ....----- ----------- -------------- •. ---- ...... .......... Final Inspection by:.. Date'.. 7 _-.... __... EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 2467(P7/76 3M