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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No.7110 "F/. --------------------------------------------------------- p -------------- ------ This Permit Expires 1 Year From bate Issued Date Issued_./__-v �_-�� 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 : .. - r- --�_'_ __L c - ---- -----------CENSU S"TRACT-----. Owner's Name -- ------------------------------------------ -- ------- Phone----------------- --- ----- ------ ---- Address -------- -Ci -. tY- -------------Zip--- --------- ---------------- Contractor's Name_ e' ------- ----- - r� . # zP ,� Ph ; License , ane = ----- ., Installation:willF serve: Residence EJApartment HoOse Ej Commercial [] Trailer Court ❑ ;_. . Motel - - Number of living Nu bedrooms.,____ i Size _-Garbagerinder_V`.__ Ltt _. _ r - -- _ --- _ — ------------ Water Supply. stem andameG - - - _ Private .:� Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam [] Clay Loam f p Hardpan ❑ Adobe ❑ Fill Material_ -,,If yes, type_____________________-------- (Plot -_(Plot plan, showing 'size of lot, location of system in relation to.wells,-buildings, etc. must be placed on reverse side.) [ NEW INSTALLATION6"'"(Nonseptic tank or 'seepage pit permitted'if public sewer is available within 200 feet,) .PACKAGE TREATMENT` [ J' ! SEPTIC TANK X"_G7_ { ; -. .. - -•: - f- � f _ . �-- -Liquid'Depth"-•---�- -- �--- ------- - Ca acitY•_f�p L 'TYPe_ � Com----- �- " -Mate _. _ __ f Distance to,neaest:.Well ___ -�-----' .--Foundation._ "l0,%�`.,___---Prop. Line ""- •G LINE No. of ngLEACHINLines _.Leth'of•each line_._'___-- _d__ _ Total Length JZ.o � F D' Box _-- __Type Filter Material_ ___- "-D'eptf�.Filter Material--C�-----)-I?_it ! Distance to nearest: Well--------[ Foundation-------- � r Property Line :_ w -'S ---- ----- - SEEPAGE PIT [ _ Depth.-----44-(.Diameter---- 3-'3---{----Number---=---- r = :. ;, kF , e N -------------- -Rock Size-J-: X Roc Filled 'Yes s o ' Water Table:Depth. ��. { _�; _ Distance to nearest: Well__ _.____________" Foundation____1__ __----------- Sr - Prop. Line --------------- _ REPAIR/ADDITION (Prev. Sanitation Permit#--------- -y_ - -,.,--,Date------' -------------------------------- _.__.__._s ____ ______ Septic Tank(Specify Requirements):---- -_- ---------------------=-----~- - ' Disposal Field (Specify.Requirements)_____ ______________ ___- -------------------------- -- -------------- -- --=------ --- ------ -- = ----- 4 Draw existin and re wired addition on reverse side) _ I herebycertify 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 mannerasto become subject to Workman's. Compensation Jaws of California." . .: I Signed.:-.-:------ = _. .. _ - -:Owner -- -- Title (If other than:owner} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _-f --DATE.--..-,-- .t 77 ---------------------------------- DIVISION OF LAND NUMBER---------- - E -- -------- ,:.:--------- '----•- --------------------------- -- -!��- -- - . .. ,.__.DAT -- --�---------- -R-�----<-- --•----- ---� ADDITIONAL COMMENTS--------- --------------------------- _ --------- - _----- --------- = --- ---------------------------------------------------------------------------------------------------------------- --- Final Inspection by::_-- = __3 - ---._-Date :'r -- - ---r _ - tUIN EN 13 24SAN J LOCAL HEALTH DISTRICT F&5 21677 REV. 7/76 3M