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FOR OFFICE USE: FOR UFFICE USE: -� APPLICATION FOR SANITATION PERMIT � Permit No.7.�'. ,� (Complete in Triplicate) ---------------------------- ................. 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 install the work herein described. , This application is made in compliance.with County Ordinance No. 544 and existing Rules and Regulations: ] r JOB ADDRESS/LOCATION.------ =/-- ........ -......1C.C".1��37t1...1/- ----- - ---------------CENSUS TRACT.....-- ...... G Owner's Name --- -- . .... . -------------------------- ----------- 7W •--.:--: / W ---------- Address _? � ............. City /9 G.. Phone Zip -............ Contractor's Name `�� F �- .G ... ---.License #. __�' Phone_ .�a � j Installation will serve, Residence/g Apartment House ❑ Commercial ❑ Trailer Court ❑ ' Motel ❑ Other------- --------- ----------- / 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,} !� PACKAGE.T-REATMENT J.] _SEPTIC TANK-[.-]- Siize....�,]��-��-�--�-•--•----------------------Liquid Depth. 7------------- �.._ T e .. � M aterial- ---------- No. Compartments.............. Capacity xk ..... yp !' .. l •. Distance to nearest: Well..:_: -. ----- --- ---Foundation.16. Prop. Line. - ,�-------- .�. T ....Total Length ..rl�.r ..---- -- --------- LINE [ ] No. of Lines -- 0.-------- of eac'lirie7— ----------- Depth _-------------= " 4 fr9 t LEACHING /De th Filter Mate�aT: ------- ------ i 'D' Box__....1 _ Type Filter Material�c X,A p `.7Llne.. O .-�7 Property Distance.to nearest: Weil..jam---------------.Foundation_c..1�-....---.-.. p Y ;'" SEEPAGE PIT [ ] Depth:... --- Diameter_.—.-----..-.- --Num� ber=--:<�-----�----------------•----- Rock Filled Yes.�, ❑ No f Water Table Depth -------------------------------- ...-..Rock Size...-- ........... -------- ------------- Distance to nearest: Well----------------- ------ - - - ----------Foundation.------ ...........Prop. Line... --- - ------ REPAIR/ADDITION (Prev. Sanitation Permit#----------------- ---- - .... --------Date........•.........-------=----- -- ----- --- } i kSeptic Tank (Specify Requirements)................ -------------------- - - -------- - ------ F . Disposal Field (Specify Requirements)_.............. ....-•-----•------....- ....................... �. --- ........... 'F (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, t shall not employ any person in such manner as to become subject W kman's Compensation laws of California." 1 r t Signed---- +-/--------- ----- ------ ---------... Owner tel ' - -- - r ------Title----------- --------- (if other than owner) eFOR DEPARTMEIII U ONLY APPLICATION ACCEPTED BY.-..--- -.... ...... .DATE rt, --- ---- DATE:.--..:. . • = DIVISION OF LAND NUMBER. - "- - ADDITIONAL COMMENTS.. .:. ------_---- . ------- ------ I . h: :: _::: :::::: : :: ::::: : ::::.. .: :: : ------------- -----------.. - : : oat `_ by .:;Final,Inspdcilon I5 21677 REV. 7/76 3M ( EN 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT