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k FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------- ----------------- * Permit No....77 - - (Complete in Triplicate) --------------------------------------------------- ---- „ Date lssued_,�3 This Permit Expires 1 Year From Date Issued -5-77 k Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Thisapplication is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: O 1407:5 JOB AD -- --- .__------- -u------ -- -- -CENSUS TRACT Address = Owner's Name. - ---- ----------------------------- -Phone---------------- �f GS'�c? - aC .� ,---------------------- City-------------- ---Zip------------------------- - -- Contractor's Name_____.. ------License #-------Z P -2 --Phone---------------- Installation will serve: Residence ❑ Apartment House❑ Commercial Trailer Court ❑ Motel ❑ Other_..------- 9 -t '---� �--^ - Number,of living units:____ ________Number of bedrooms___y_Garbage Grinder------------ Size_____ _ __.__-_..._-.._`, Water Supply: Public System and name------------------------------------ -------------------------------------------------------------- ----- ---------------------Private 34N Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan Adobe ❑ Fill Material--_---------If yes, type.------------------------- ___- V (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,) `t/__- / PACKAGE TREATMENT [ ] SEPTICTANK [� Size_ _�,; tf`__�___111e, ------------------------- Depth_ -- Liquid Depth __,____ Capacity) � -------Type=-`-'"i- Material_ j -(�------------No. Compartments-----y------ ------ --- ----- r Distance to nearest: Well'_---------_�,c*_,A�----._._______.Foundation.,_____ Prop. Line �.�~_____. r LEACHING LINE [ No. of Lines--------Y_____- Length of each line--------V U- --------Total Length ---9_a__ --------------------- 'D' ------------- -D' Box-----f__..-Type Filter Material-------- Moterial------ -------------------------------------------------- Distance _________________ __________._Distance to nearest: Well---------S-0--1--------Foundation-------- -----------Property Line-------17_________ SEEPAGE PIT [ ' Depth..__ _ -__Diameter.- -_._.__Number________._�------------------ Rock Filled YesNo ❑ / i Water Table Depth----- --- - !�_ ---------------------------Rock Size---�/� -.,--X 3-f----------------- � st ! 1 Distance to nearest: Well_.-------i-Vt_-.�-�'-------------Foundation__ —____.Prop. Line------- REPAIR/ADDITION (Prev. Sanitation Permit#------------------ --------------------------------Date.--_------------------------------------------1 SepticTank (Specify Requirements)--------------------------------------------------- --------------------------------------------------------- -------------------------------- ------ ---- DisposalField (Specify Requirements)--------- -------------------------------------------------------------- --------------------------------------- --------------------- -- ) -------------:--------------------------------- --- ----------------------------------------------------------- --------------------------------------- -------------------------------- ------------------------ -------------,----------------•---•----------------------- -------------------------------------------------------------- ------------------------------------------------------------- --------------------------- (Draw existing and required addition on reverse side) 1 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 shalllnot employ any person in such manner as togbeco'me subject to Workman's Co pensation laws of -California." Signed.-: By-------=L------------------------- ---- -- Title (If other than owner) ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----_---_ _________________DATE. DIVISION OF LAND NUMBER. ------------ ---------- ----- -------------------------------------- ------------------------------DATE.------------------- ----- --- -- ADDITIONALCOMMENTS------- --------- ----------------------- ------------------------ ---------------- -------------- ----- --------- ---- ---- ---- -- ------------------ - ------------- ----- Final Inspection by:_._-__.___�._-___ ______ Z " --- -------------------- ---------------------------------------------------------- ----------------------Date EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7/76 3M