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-FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR 5ANITATION PERMIT (Complete in Triplicate) Permit No. 7-�_--� ----- _,� � 7y 'Seem" --------- 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: JOB ADDRESS/LOTION �. " -----------'-- ----------,-..__ _ CENSUS TRACT --------------- Owner's Name. ! � �5� . ... Phone------------- ------------------ Address - - -- Address- c. J _ City • Zip--j 7 -- --- ... ... Contractors Name--L _, �-- -�.__ - -- -. ------ _License #_J_J . 4_-,� ---Phone--_ ----------- Installation will serve: f dente Apartment House ❑ Commercial ❑ Trailer Court ❑ OteI ❑ Other _.-.-- Number of living units:............ _Number of bedrooms__ Garbage Grinder .Lot Size__...... _ ... ... .. . ........------_..______--- Water Supply: Public System and name------- --------- -------- -.---- _ _ - - Private Q 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,) vy PACKAGE TREATMENT [ ] SEPTIC TANK [ j Size r _.. ..... ___.._._.Liquid Depth._. c Capacity. d ' I'y�5e - ` 'r`" Material ........... No. Compartments ::;� Distance to nearest: Well---14Z'.-f----------------------------Foundationle, ------Prop. Line _- LEACHING LINE [ ] No. of Lines.. .............. ...... Length of each line_ .�. ______Total Length ... .�lf.�. 'D' Box Type Filter Material_ c' Depth Filter Material__ .._.--- -------------------------------------- ........... -._h Distanceto nearest: Well _ __ _ ---_Foundation Property Line _ v Diameter Number Rock Filled Yes No SEEPAGE PIT [ ] Depth....-..- .._ ❑ ❑� Water Table Depth - - ------------------------------Rock Size-- --------- Distance to nearest: Well ---- -------------------Foundation Prop. Line__ REPAIR/ADDITION {Prev. Sanitation Permit#_ - -- _ ---------- ---------Date._ ___ _ --- - ----- -- --- ) Septic Tank (Specify Requirements)_ _ _ __ Disposal Field (Specify Requirements) (Draw existing and required addition on reverse side) I Thereby 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, I shall not employ any person in such manner as to become subject to Workman's .Compensation laws of California." Signed - - ----- . .. . __....._Owner By _ ------- ------------------------ --- ...........Title (If other than owner) FOR DEPARTME USE ONLY APPLICATION ACCEPTED BYQATE --f 10 DIVISION OF LAND NUMBER ---------- - ---------- ----------------------------.------ -- --------- ----- - DATE---- ADDITIONALCOMMENTS--------- -------- --------- -------------- - ------------- ------------------- -- ...... --- -.....------------------ ---------------- ---- ----- ----- ---------------------- .---- ------- --- --.------------------------- _ -------ji �--- --- --------------------------------------------------------- ------------- --- ------ - ------------------ --------- -- Final Inspection by: r_ --- --- -- _ Date---- EH EH z3 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Ess 21677 REV. 7/76 3M