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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT •�7 ` .� :- in Triplicatel'+ - ; Permit No -_ ------------ ------ " � �{Complete r~+� x` t` i !-l—_. D-7 •-•-------------------------------------___----__-----_ This Permit Expires 1 Year From Date_ issued Date Issued__. 7 Application is hereby made to the San Joaquin Local Health District for a permit to construct andinstallthe work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: �. . _ JOB ADDRESS/LO ION.--_�� -- - -� ------ ------- - - i Owner's Name_ � � CENSUSTRACT. Phone_ --- ----- --- ` Address--AY-514-f .. --- �y --------------City, �•1 ��-� ., zi1; .0 ' Contractor's Name.--( -- -`--- -- - - --- C�--- � ------ --=------=--------- License /� 3 -__---Phone--- i --------- # -- �- 9 -------------- Installation ___ ____Installation will serve: Residence ® --� partment House ❑ Commercial n�-Tr a:iler Court , ,( r Motel ❑.,►Other Number of living units:---_/-:------Number of.bedroo,.bedrooms _-.Garr} e Grinder-------.-__-Lot Size__Rd - g Water Supply: Public System and name .___.- - n r t_ _-_ - __ Private - - Character of soil to a depth of 3 feet; Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy L pm ❑ Clay Loam Hardpan El Adobe E] Fill Material___---------If yes, type- :_=-._.---__ 5 ' r i i (Plot plan, showing size of lot, location of system in relation to wells,`buildings, etc. must be placed on reverse side.) i NEW INSTALLATION: (No 'septic tank or seepagepit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT [,] SEPTIC TANK Size-- = =------ ------=------t-------------------Liquid Depth.---------- ---------- Capacity -- -- Capacity--=-------------*'--;Type----- --= ; :-Material -------------- ------$-No. Compartments� ------------------- 7 9 a .Distance to nearest: Well- _ ` . .. - r .. Foundation----------------- --- ,-Prop. Line- --------------- LEACHING LINE [ 1 No. of Limes,------- '--- __-4_-Length of , each. s ---------------- Length';__,---____----- • - - - _-. --------- r D'.Box------------Type_Filter Material:--------------- ----Depth Filter Material-.------------ --:----- 9 Distanceto nearest: Welly _--._-_------___--- Foundation- _---------------------- ---Property Line i SEEPAGE PIT :[ ];';, Depth----------------Diameter-------------------- Number----------=--- `--------•----- Rock Filled`Yes ❑ No ❑ �, -.. Water Table;Depth- '------ ----- = - ` _'.._ .Rock Size Y ------- i `Distance to nearest: Well--- --------------- -- -- -- --------Foundcition = = ' .Prop. Line--------- REPAIR/ADDITION (Prev. Sanitation Permit#_,------- --------------------- ' -----------Date_ r I. f . ------------------------- Septic Tank (Specify Requirements)-------------- -- -------, � --,- . - = Disposal Field (Specify Requirements).__ ------------ --------------- _ _--------------- --- - + _.. �! ----------- -------- ----- -- - - -- ------- --- '(Draw'existing and required addition on reverse side) s --- ----------------------------- 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 � 1 signature certifies th'e'-following: � � � 4. `l certify that in the performance of the work for which this permit,is issued, l shall not employ any person in such 'mannerlas., :E to become lec to Work . n�pensatron-l7. aws of-California.'.' . Signe r d --- i � .. -- ---- :Owns }.. - f BY Title (If other than'owne '-- --------:. } - - - "FOR DEPARTMENT USE ONLY s '` APPLICATION ACCEPTED BY._--- __ _ --.DATE.:"--?� DIVISION OF LAND NUMBER:______,--- - =_ _.___--.:____- ' --------.-DATE ADDITIONAL COMMENTS--------------------------- i -------------- ---------- = ---------- ----------------- ------ ------ ----- - ------ ----------------- -----------=------ ----- --------------------------------------- p = Final•Inspection by._= = . . a e - _ ---" �""--D------ - ------ EH 13 24 � SAN JOAQUI LOCAL HEALTH DISTRICT F&5 21677 REV. 7/76 3m ? r