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FOR OFFICE USL: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 -�� ------- Permit No./" � ......... . . ........ (Complete in Triplicate} C y.--."--. ..---. ... Date issued „_------- ------- 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,instali the work herein described, This application is made in compliance with County Ordinance No- 549 and existing Ru es and Regulations: CENSUS TRACT_ JOBN. _ ADDRESS/LOCATIO __..- ...... . .� er? ---Phone.? �-...-s�---- ...... ---- Owner's Name ........Ma---- --- Address- lop) . City- ................. ..-- Zip -- ---------- ------- --- Contractor's Name"----- ---------�- - -License... .---.�.---- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other--- -------- ------------------ � _ ---- Number of living units:..--- of bedrooms. -"_ . Garbage Grinder--_.---- - Lot Size-- ` .private Water Supply: Public System and name-- --- ------ --- ------- ......... Character of soil to a depth of 3 feet: . Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan C] 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.} F NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 19 , PACKAGE TREATMENT I } SEPTIC TANK Size _V. �a'� - E�- ,�-(�---..-- Liquid Depth." .."--- ( .- ., -•-No. ,Com artments------ Material �----Capacity_.�_� d"-...Type a T ..... r ----.>=oundation. -.-Q. --.-..._ ...Prop. Line---•--- Distance to nearest: Well--..�-----�... ........ e `e LEACHING LINE No. of Lines ..-.. ------ Length of each hne..11-�---- -- - Total Length ... .--��- -- - i+/ �" Ip ......----- 'D' Box-..._."..:.Type Filter Mater�al....-�- .Depth Filter.Material...� ..-.---..- e / . Property Line....�------ ....... ---------- Distance to nearest: Well.-. _--- Foundation--. -��------- P Y 3 ....Number"..-c� --------------------- ./ .� Rock Filled YesX No SEEPAGE PIT jy� Depth- - --Diameter..-1.------- �l --.--.Rock Size..O��'3----- --- --------------------- -- Water Table Depth-----•--/-aa----..----- ... , / Distance to nearest: Well._.--�-Q-Q.----- --�----- ... ------Foundation-.. ...Q-=Q.-. .....Prop, Line_ --.----- --.... REPAIR/ADDITION (Prev. Sanitation Permit#--..-----------:--••-... -.-- ... .." --...Date------------------------- ---- -- -----------) ....................... - Septic Tank {Specify Requirements)-.,_,...- - --------- ........ . . ..... ------.--- - ---- . -- ------- Disposal Field (Specify Requirements)..........."----------. • -- _. ...... (Draw existing and required addition on reverse side) t 1 hereby certify that I have prepared this application and that the work wili accordance with San Joaquin County be done in 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 t Workman' omp nsation Taws of California." Signed-------- - ----- .:�� -�-- nowner) ......Owner �. By--------- -----------------------------"---------- . Title.......... .. ...R-- ----... --- -----��-..._(If other tha FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. - - . -------- ---- -- --- --- --- DATE - ..... ...... .-.-_.. DAT DIVISION OF LANb NUMBE ADDITIONAL COMMENTS....---- -•-------- ----------------- ------- ------ - i _-...... --- ----- ------- -------- --------- .----- ........ -------- - -------------- ----------------------Final Insged1on by:.. - F85 24677 REV. 7/76 W EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT