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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No.-, -9-.�-3. ---------------------------------- --- . O Date Issued •-...•..•.........................................t'...... This Permit Expires 1 Year from Date Issues! 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/LOCATION. --- - - .. -,CENSUS TRACT..-------.-----------............ Owner's Name. - - 2�1 �-..1. ... . -.�. ---------• Phone �.`-�------ . Address.. 1 .'_L�t/<� ._.. - --- ..... --......Zip Contractor's Name--------------- --� �-'�- ............... -- License #..��_.�f.�!�. .. .Phone_��.._.7�/�..-_. Installation will serve: Residence ( Apartment House ❑ Commercial ❑ Trailer.Court ❑ Motel ❑ Other............... Number of living units:___.....--Number of bedrooms- ., -Garbage Grinder------------Lot Size..02.J4...X..y4_Y-,..... Water Supply: Public System and name---- ------------ ...............-...............:......................... ............-•--- -- .......... ----------:------Private [� Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Gay Loam ❑ 'i 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,) '1 PACKAGE TREATMENT [ } SEPTIC TANK [Xj Size.... SX -------- "_.:- .-.--..-..Liquid Depth..:_-..--- ..... Capacity./, 6.4>------Type _ .� ..Material ...--------No. Compartments_ -....-_.caw..'. e Distance to nearest: Well.-/&.0-----------------------------Foundation--- U---- -.-----.Prop. Line-- ---.--......-----.� LEACHING LINE [ No. of;1ines.... -------------------Length of each fine...*05------ Total Length . Type �� Depth Filter Material- --��-� - .. ---- D` Box__......._.T a Filter Material.......�� ---- ----------- ...---. - - Distance to nearest: Well---14.1... . -.-- Foundation-_07,5 ........_------Property Line_.:$P_....................... SEEPAGE PIT [ Depth-._v,.S Diameter.... 3...........Number------02..................... Rock Filled Yes ' No L] Water Table Depth.............eQ.Q.- ----- ....Rock Size 0 .1v i Distance to nearest: Well....l- -----------------------'..Foundation... .mF7...........Prop. Line..5..-._...--..._.... REPAIR/ADDITION (Prev. Sanitation Permit#...............:................... ... Date---------------------- --------------1 ` Septic Tank (Specify Requirements)................................... Disposal Field (Specify Requirements).... : .. ..----• ------------------------------------- -------•--- -- - -- -------------- ---------------- ......--- --...:.--- ------------- ---------------------------------- -------- --- ------------------------------------- ----------- .......... (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, I shall not employ any person in such manner as i -to become subject Workman's Comp satlon laws of California." Signed---- -Owner By.. ............ ------------ - --------------------- ..... ........ ..................................... (If other than owner) FOR EPART ENT USE ONLY 11,6177 APPLICAT DIVISION IOF LAND NUMBER_.. � ...?..�. 1.<!.3__ ..... - ---------- DATE _-_--a-- ----- ------- ----------- -- -- - ADDITIONAL COMMENTS. �,,�kr�..4 .---.---R.I7.Z_ �5------- ------- ---------- _....... ----- -----------. ----------- � .. -- . ----•-- --------- ---- -------.------------------------------ -------------......-- ---------------- --------- ........ I ----------------------- ------ ------ --- --- ... ....-- --------•- - - .....- Final Inspection by:...- — -.... - Date-- �� -�[ Fas 21677 REV. 7/76 1M EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT 1