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FOR OFFICEUSE: . / FOR OFFICE USE: ' {� APPLICATION F02 SANITATION PERMIT ------------------------- -- -- ...... ----------- (Complete in Triplicate} Permit No..7,f�..5. .--.. -------------------•-----............... ------ - Date Issued..... ---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 PZ No. 549 and existing Rules and Regulations: ' JOB ADDRESS/LOCATION_ .(<j ,�....-.--L� ......T.i,!('// - Q� ---CENSUS TRACT............... . ............. Owner's Name.--- -----; .... � ----- - ---------- � J.----...... Address--------- _--------- City Al ..........- ----- Contractor's Name C. 41L ..1..�/d!. ... `. ,. License #.---.---- ---- - -- Phone.-;� � � Installation will serve: ResidencejW Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Ot r................ ............................. Number of living units:._,.. ......Number of bedrooms---. ......_Garbage Grind%/_45.Lot Size- . -------------_--------_ -- Water Supply: Public System and name_----- ---------- ----------- ------------------------------------------------------ --- --- -.---------.-Private ] Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ .Clay ❑ Peat ❑ Sandy Loam Z 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,[ PACKAGE TREATMENT ( ] SEPTIC TANK [ ] Size -.16.0.0------ 4.l11a0t ----- -------- _liquid Depth.............._.........1 { Capacity./400._....-Type6_6PPV.Ce610Material `J.� ---No. Compartments._.-__------._ Distance to nearest: Well........................ -------- --......-Fo��u77ndation..C9c'3. ------ -.. -.Prop. Line..-��. .......-... LEACHING LINE ( ] No. of Lines......pz................Length of each line.--.-_..!- .f`r..--.-.-Total Length .....� ��. ,fir __ ..- , D' Box...`......Type Filter Material.. _ Depth Filte ateriol----.. .. .._.-.. Distance to nearest: Well.... �.. .. .�--._.Foundation_.. .�d.��....._. Property Line.._f�� J� . �tt r� P Y SEEPAGE PIT [ ] Depthp24 _4Diameter.l�/i��.e....Number....o4 --------- ------------ Rock Filled esqa No Water Tab a Depth--------------- ----------- ---..Rock Size.- �a � --_---._....-- Distance to nearest: Well.... .. .. ........ . Foundation...,�cc�c�~ - -. Prop. Line_��v. . _-.._..... REPAIR/ADDITION (Prev. Sanitation Permit# e?---.....-.-- -.Date----....------ .-------.. ------------ } Septic Tank (Specify Requirements)-- ....................... ---------_-------------- ----- ------------ Disposal Field (Specify Requirements)- -------------------- --------------- -_- ------•------------------ -- --------------- ------ ------------------------------------ --- ---- ------- --...........�- 41 -------------- ----------- -------------------------------------------- ----------------•------------------------------------- ---- --------------------------------- .. (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 fallowing: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensati laws of California." Signed... ...... . ... . .....------ Owner By...... ----------------------- ---------- ..........Title....------ -------- (If other than owner) FOR EP RTMENT USE ONLY APPLICATION ACCEPTED BY-..---.... Wit. --- .. . . . --- ----------------- ------------DATE --- ........ OF LAND NUMBER.............. .. ----------.DATE.-.- ------ ADDITIONAL _ .ADDITIONAL COMMENTS- ..... .. x �...- �.- 7�'---- -- -_-- -------- -------------------- -.---------•----------. ----- ......._...__.. -------------------- - ---- --- ------------- ----- -- --------- -- - ...... ••. ----- --_------------------ ---- :..... ------------ ------------------------------------------------- Final Inspection by:................ ---------------------------Date.---- --- C�.. .. EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21h77 RfV. 7/76 3M