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FOR,OFFICE USE: FOR OFFICE USE: <br /> ................................. ....... ............. APPLICATION FOR SANITATION PERMITPermit No....7��-�.-(Complete in in Triplicate) <br /> ----------- •------ 7 <br /> 0' <br /> Date Issued_ .. ............ <br /> ......................................................... This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> [/-I;5./-3_ <br /> II Q <br /> JOB ADDRESS/LOCATION........./. �.l..3... -.SU N. ..90QcJ.. ) �I I�IJ ...CENSUS TRACT.....--•- --- <br /> Owner's Name.-.. , �sC .l....Q.�......�a.� S-� J • �.L..._....... Phone I-Zc 8 .T----- <br /> Address----------- ..SG�N. g 7PII.... ........... ...... city-------. 7�`�!�.----------- -- .....zip .-f.5.....PS.-.....- <br /> Contractor's Name.................b- I ...... ............. ................License #...--- --------- .. --...Phone- ---------------- <br /> Installation will serve: Residence [X Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other_.. .---- ----------- ------------------ <br /> Number of living units:_..__--------Number of bedrooms...--- Garbage Grindw..:�....Lot Size..... . --- - <br /> Water Supply: Public System and name-- ---- -------- - ---------- ..Private <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam <br /> Hardpan ❑ Adobe ❑ Fill Material - _.. ....If yes, type-.-......... ---------- <br /> . <br /> {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.] <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] <br /> PACKAGE TREATMENT [ ] SEPTIC TANK 4(J Size ---- ....------ Liquid Depth.---- .-....------- -- <br /> Capocity.. ;00---.-.-TYP Ces Material--.G'O!N.c-red P No. Compartments----....:.0,2...............-- -- <br /> Distance to nearest: Well-.......7.aB. ...... .... .........Foundation__ Prop. Line_>S-..-- --- ..... - <br /> LEACHING LINE [ ] No. of Lines . ... ........A.........Length of each line....------SS--------------Total Length ..../-70-- - <br /> 'D' Box- �- ...Type Filter Material�C� i_<<- !`Depth Filter Material----------b?. ------ .------------ - -- .......... <br /> r <br /> Distance,to nearest: Well----,�,SQ............. Foundation....--T-S-------. -----Property Line.---- -- <br /> i ----------------- Rock Filled Ye No <br /> SEEPAGE PIT [ ] Depth.- .�S. ...Diameter---_3.47... .....Number.. ._. .- <br /> Water Table Depth----------•-•------ ------ ------------Rock Size_..... . ...� --------- -----... � <br /> r <br /> Distance to nearest: Well--------------7/.00....... - ------Foundation... ...... _-.Prop. Line---..:,>,S ...... ` <br /> REPAIR/ADDITION (Prev. Sanitation Permit#................................. . . .........Dote.--------------------_-.--------- ----) <br /> Septic Tank (Specify Requirements)------ -- -------- .. .. ......-----.. -----. <br /> Disposal Field (Specify Requirements).........------------- --- --•------------•----------• ---------------- --------- - <br /> ---- ------- ------ <br /> -------------------------------------------------- ---------------- - ------.....-•--..---............................ -----...-------------- _------..----- --- ........... - ........... --- --------- <br /> ----- --------- .......... . ......... ---------------- ------------­_­-- ------------------- <br /> fDrow existing and required addition on reverse side) <br /> I he certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: <br /> 44 <br /> 1 certify at 1n the per#orm nce of t ork for hick this permit is issued, l shall not employ any person in such manner as <br /> to beco a subiect r a 's om lox, aws of California." <br /> Signed. . --......-Owner <br /> By---------------- .. Title....- ......- --- ............. ---------------- ... <br /> (If other than owner) <br /> F DEP RTME LJ E O LY <br /> APPLICATION ACCEPTED BY.......- -. DATE <br /> dL�... <br /> DIVISION OF LAND NUMBER.------ DATE. <br /> ADDITIONAL COMMENTS.- -- ---............. .. <br /> ----------------- --- --------------- ----- - ..------ <br /> Final Inspection b ... .. Ff �f-- ------ ---------- ----- <br /> c G'�ir.c - ��1 °L QCC•�_ Lw rl. Date.... <br /> EH 13 24 "e �jn/.�cr ,n/sWi cTib^> SAN JOAQUIN LOCAL HEALTH DISTRICT F85 21677 REV. 7/76 3M <br />