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FOR OFFICE USE: �� FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 '� 7 ------------ --- ------- ------------------------------- (Complete in Triplicate) Permit No,7_2._-W7 T ------------------------------ �� ----- Date Issued---- ------7 -__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 and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ; JOB ADDRESS/LOCATION-----.. - D+ -------- -------------- -------- -CENSUS TRACT--------------------------------- .2 -------------------- ----- Owner's Name------ ------------- Phone_ —_/- _ Address ` -- ------- City------ �' `---------------zip ------------------ -------- Contractor's Name.-:_ - � .-._. _. l2Ls -_' icense # Phone Installation will serve: Residence Apartment House❑ Commercial ❑ Trailer Court ❑ �MoYel ❑ Other------------------------ - ------------- ------ g ifs �o Number of living units----- -----------Number of bedrooms`._ : finder_.------____Lot.Size______._ __ _-_-- Garloa e Gr Water Supply: Public System and name--------------_-'-:�_...__t": - -_.-:- �_. Private Character of soil to a depth of 3 feet:—Sand [] Silt[I Clay ❑ :Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe P< Fill Material---------- _If yes, type-------------------------------- (Plot plan, showing size of lot, locatiarl;of system_jn relation-to.wells,_build(ags, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] Vim" PACKAGE TREATMENT [ ] ' SEPTIC TANK- ] ize_-- -_- -- ------•-------------------------Liquid Depth --------------------No. Compartments_-___ ____ Capacity : - --- ;pe --- I eri- -h s�1 ----! Distance to nearest. Well______ __ Foundation------ L __ Prop. Line------------------ - r , LEACHING LINE ' Na. of Lines--------- --------------- Length of ea 1ina.:_ ,_" -- --,.-:=.Total e4gth:-4-----"�----- ------------ ------------------------------ ----- D' Box_--____..:Type Filter Material_._ ---- . _- -`-Depth Filter Material _ __ � Distance to nearest: Weli�+ _ oundatian___._�_4A_ _____________.Property Line-._--_--:______________________ SEEPAGE PIT Depth __,_{_-Diameter_._` _ _._____Number_.-----/_______________________ �/& Rock Filled Yes; No ❑ 11I0 If Water Table Depth.-/"-[ 7�-------- - -----------------------Rock Size.l -------------------------- e l Distance to nearest: Well - ---- -------------------------Foundation_.._. V__ ------ Prop. Line---------------------------. REPAIR/ADDITION (Prev, Sanitation Permit#---------------------------------------------------Date----------------:-----------------------------1 Septic Tank (Specify Requirements)------------------- - -------- - ---- P Disposal Field (Specify Requirements)----- - -- ---- y ---------------- - / �y '.''------- ------------------------- -------------------- 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 ftrformance of the work for which this permit is issued, I shall not employ any person in such manner as to become sub'ect t ork�mgn's Cam ensation I ws of California." t Signed--- -----tea', ----------------- By -' ; f7- BY --------- - ---------------- ----- -- -----------Title---- � ----- — ------ - - - - -- ---- -------tDEP (If other'than owner) FORRTMENT USE ONLY APPLICATION ACCEPTED by ---------- ---------- DATE._c -=�Z.f - DIVISIONOF LAND NUMBER-------------------- ----------------------------------------------------------------- - --------- ----DATE------------- ---------------- -------------5 ADDITIONALCOMMENTS ------- ---- -------- ----------- ---------- ---- --------- ---------------- --------=----------------------.------------------------- ------------------------- -- --- -------------- --- ---------- -------------------------------------------- ------------------------------- ------ 7--------------- ------------------------- ------ ------ --- ---------------- Date.± - - --- - - --------- ---- Final Inspection bY: sr == /-��'rb EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F8s 2167 �f+�. 76 3M