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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 ------------------ Permit No.- --------------- -------------- o. 7. """"-----�--- �"""""----""""""�" {Complete in Triplicate} -------------- i- �_/-_7 Date Issued_A...... 7 ----------------- ----------------- This Permit Expires 1 Year From Date Issued ----------------- f y Application is hereby made to the San Joaquin Local'Hea th District fora permit to construct and.install the work herein described. This application is made in compliance with County Ordinance No.-549 and existing Rules.ard Regulations: CENSUS TRACT.-_ JOB ADDRESS/LOCATION---- / ,( r Owner's Name - - -- ' Address ---- --------------- - ---- -- ----- -------------------------City----------------------------J--- ------ ------Zip---------------------- Contractor's Name--- - - - ---------- ------ -----------License # , Q S1:FI---- Phone-- -- L�J-`T. 7 J.-a-_ Installation will serve: Residence Apartm nt House 71 Commercial E] Trailer Court ❑ tel ❑ Other------------------------ ----------------------- Number ------------- ----Number of living units:----.---------Number of bedrooms-J; 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 ❑ 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 public sewer is available within 200 feet,) r PACKAGE TREATMENT ] ] SEPTIC TANK [ ] Size---- i..` ""�"T �0-------' ----------Liquid Depth --- ------------------- Capacity Type Material '-No. Compartments---1.9 -------------------- 6 Distance to nearest; Well..../_6----p.. .-..--I-----------Foundation-.--1117___- ------Prop. Line-----19-? 5 .-..------ LEACHING LINE [ ] Na, of Lines,____ :.. - Length of each-line. _. -(�� --�-------Total Length j19�----------------------- -- 'D' Box--_4------Type Filter Material---6 -" ------Depth Filter Material----- --��-------------------------------------------- Distance to nearest: Well..�(_.C2------ oundation..----_--------------------Property Line----------------------------------- SEEPAGE PIT [ ] Depth..Ai_1__..Diameter---- __ ------Number----�3------------------------ Rock Filled Yes�^ No ❑ ' WaterTable Depth-------------------------------------------------------- Rock Size--; ---------- ---------------- Distance to nearest: Well--}----------------------------------------Foundation-----{----------- ------.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 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 Compensatio-n laws of California." Signed ------ --- -- Owner By--------r - - ------ ----- 7� - -{ --- ---------Title-------- -------------------- -------------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- - - - ---->��---------- DATE 1�.�2-1-.7 --------- -- - ------ DIVISIONOF LAND NUMBER-------------- --- ------ ---------DATE.----------------- ----------------------------- ADDITIONAL COMMENTS- --------------------------------------------------- --------------------------------------------- --------------------------------------- --------------------- ------ - ----------------------- ----------------------------- --------------------------------------------------- ------------------ ----------------------------------------------- ------------------------------------------------- ----------- -------------------------------------------------- ---- ----------------- ------------------------ ----------------------------------- - ------------- --------------------------------------------------------------- Final Inspection by=------------- } - . ----- -- a------- -------------------Date---- T EH 13 24 / SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7/76 3M