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` Vv i FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------------------------------------------------- Permit No... s R (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. 549 and existing Rules and Regulations: b JOB ADDRESS/LOCAT N. QdU j� ....r . .- -----------..CENSUS TRACT-------------------------- -- -r Owner's Name "' Phone baa a� -- Address---------- - ------ •- -------- ---- -------- -- - City - --- ------- ------------Z�p 's Name ��- --------_ _License #-P 1�f",4 Phone ��------------------------- Contractor i �- Installation will serve: Residence Apartment House ❑ _Commercial ❑ Trailer Court ❑ iF / Motel 7-1 -.Other--------------------;--------- - - - --------- f Number of living units:- _( ------Number of bedrooms_-.- ---Garbage Grinder------------Lot Size__________________ _______ - ----------------------- WaterSupply: Public System and name------------------•---------------------------:----------- --------------.- --.---=------------ -----------------------------------------Private kr Character of soil to a depth of 3 feet: . Sand ❑- Silt❑ Clay ❑_ Peat,❑__. Sandy_Loam ❑_'Clay Loam.❑ Hardpan❑' Adobe. ''�,.1 iIl,Material-. Y_:�: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 eet] h.._' ------------------- 1—a- __/__________ ___ 4 PACKAGE TREATMENT [ 1 SEPTIC TANK [� ��S r � _ --- iGapdcity- :TYPep '& -----Materiaf,V .- -NA. Compartments.�T��--`--n � Distance to nearest: Well. - _a---=------------------------Foundation-.._/4.------------_--Prop. ine--- ---------------- LEACHING LINE [+-}� No. of Lines---- C--- u, �: Length of each line.-__ ��_�__- S-.,._,_.Tota l/Length._._..._. �_--__-----.-_--_--- ' 'D' Box-..- --_-.T e Filter-Materia-1 -ST Filter NTater�ia{_ wL_ - __ �---- --=� i y� �c� r [ Distance to nearest: Well-- fQ� _______-- Property Line.-- _ _Foundation.-.-_ -_�__ --/- � _ -- ---------- ..Rock Fill Yes�' No❑,tr SEEPAGE PIT { t" - Depth-44 -- -- - - _r r ._ ' Water Table 'Depth- ---.- -Q---- - Number---- ---------Rock Size--.- , � -- -- �x�-�--=-- -- -- ----------- � ��, -----Foundation-------�Q-.........Pro Line---r��----- --- ---© t Distance Ito nearest: Well...-------- ------------------- p I REPAIR/ADDITION (Prev. Sanitation Permit#----------------=----------------------------------Date{- ---------------------------------------- -) �. Septic Tank [Specify Requirements) - ----------------------- ------------------------------------'----- i Disposal Field (Specify Requirements-) ---------_--------- � -- ------------ --------------------------t--- ------=---------- ----------- ----=---------------,----- ----------- --------------------- ------------------------- ------------- ------ - ------------------------------------------------------- --------------------------------------------------------------------- ------------------- {Draw existing and required addition on reverse side} \. I hereby certify that I have prepared this application and that the work will W done in accordance with San Joaquin County Ordinances, State Laws, and Rules land Regulations,of the San Joaquin Local Health District, Home owner or.licensed agents.;- fx signature certifies the following: r1 I "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 1, to become s� ' t to.Woran smpensation I4w5 of California.'; .jVn � ,. Owner ------- --------- / -- --.------- - --------Signed- BYt Title-------- { j - r l (�0_ r'than ;owner) = .{ FOR DEPARTMENT USE ONLY: fi APPLICATION ACCEPTED BY- _ ---_-------------- ----- -- DATE. 7 DIVISIONOF LAND NUMBER. - ------------------- ------------------DATE.-------- - -------•---------- -- --------1- -- - ADDITIONAL COMMENTS.-__. / ' Ql� I' - ------ - - ----- -- ---- -- --- - ---------------------- ------------------------------------------------- -- -- ------------- ---------------------------- f ------------------------------------------ -1 s - -------- ----------------------------------- ----------- — -------------------------------- - ----------------------------------Final Inspection b --- ------ --Date t.__.. EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT 7 REV. 7/76 3M