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FGR OFFICE USE: FOR OFFICE USE: `- F ------------------------------------------------------- APPLICATION FOR SANITATION PERMIT" R( .. Permit No.71-7 P��Complete.in:Triolicate}-, S ________________.__-_____._____.._._______.__._.__..______ a l� C .Date issued_lD-/ .-._-__-____________________________._--.______..___.__ :his 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 C my dinance No. 519 and existing Rules and Regulations: �. JOB ADDRESS/LOC TON. f US TRAC - = -- ---- -- -- - = Owner's Name =' ------------- -'- - -.- --= Phone ,. w 44 Address , . -------- ----------C, Zip-- -- ------------------- Address' -------' -- Contractor's Name_____._ q �; -- " ------ ----- �------------L'inse ;# Thi j F- Phone Installation will serve: F Residence [Apartment House Commercial ❑ Trailer Court [] - Motel ❑ Other ='------ t---- =- :-------------------= 4 3 c� I , Number of living units:__:_.__"....,__.._Nu.rnber of bedroom5_,-_.,_______Garbage Grinder_--.__- ..=Lot Size_ lS�__________________,- ' / 5 v t '"----------F W Ater Supply: Public System land.name .:1-.---:-- ----------- --- ------= L ----- ------------------------------- -.Private ❑ . Character of soil to a depth of 3 feet: ` Sand ❑ Silt ❑ 'Clay 0 Peat ❑ Sandy Loam 0 Clay Loam ❑ Hardpan 0 •AdobFill Material-- yes, type-------------------_________._: (Plot plan, showing size of lot, location,�,olf system in relation to'w4J, buildings,�etc_Rmust be placed on reverse side.) # NEW INSTALLATION: (No septic tank or seepage pit permitted f fpublic sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK ' Size__'-__: _"_____------_ -- "47""!- �----------Liquid Depth.'_ R rr Cap = :-..__.-=-- Type `�- . `. -__Matariai..--...__•c-_:-:�__.._.4No. Compartments._ f 1 - h- ---------- 1 i i .Dist�nce.to nearest: Well_______________'__. _. __r:` �_._Foundation==j.__=---------------------Prop. Line-------------------------_._1 Length o [ 0 LEACHING LINE; [ ] No. of Lines_"___,___._ f each lima.__.__ ._._,V-- ,:____,Total Length _.__.______ .�: ' r .D' Box._.---------Type Filter Material' I______ Depth,Filter Material______ _ ___ _ __ ____________;_.___ ---------- Distance to nearest: Well____________________ _____;_Foundation_=_,_`______ __________Property Line SEEPAGE PIT [ ] Depth------ ""D:iameter----------_---------- umber_._'_____:_.__.___.______ -1 "Rock Filled' Yes ❑ No ❑ Water Table Depth- ;:----------------------- : - -------''-------:--.Rock Size-----'-----'--`----- -- ------------------------- Distanceto'nearest:''Well-'� '-- ------=-------------Foundation-------------------'-----.Prop. Line-------------"------- ' REPAIR/ADDITION {Prev, Sanitation Permit#:"'__- ----'--° - :-y_____________________Date----------------------------------------------- Septic -----'---------Septic Tank (Specify Requirements) ---- -•--=- --== '---- _ "" .-- e ------------ - f Disposal..Field (Specify Require entss).,_._.-___- .� -------- --- i - - - ---- - -- ---- -- ---- ---- f=------ ---- --- --- -------------------------------------- -- --------------- ----------- --.---- - - --k-- ------------------------------------------------------ I (Draw existing an ed 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 tSan 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 per'.it is issued,' I shall not employ any person in such manner as to become u ject..to W rkma 's Compensation .laws of California." i Signed------ - -------- --- - --- ..------ ---.:,__-. -------Owner .. _ .... By- -------------- ---:-------- ------------------ Title----- _ ----- -'------- -------------- (if other than owned FOR-'DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY---- ' ' ---------------------------------------------------- DATE DIVISIONOF LAND NUMBER:------ ----=------ -------------------------------------------=------- -------------------------------------DATE------ -- - ---------- ------------------ ------- )): ADDITIONAL COMMENTS----------- 1+� f'� :^ " = -_ --- ---- ------ ' " ------------------ i - -----------------------------•--- -------------------------------------'-- Fina[ Inspection b ._'------ --------------------- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F85 21577 REV. 7/76 3M