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FOR OFFICE USE; FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT JA 7 .. (Complete in Triplicate) Permit No. .. .._....--.-3 -------------------------------- .................. ............., /2.. .. 71 . '•••••-•..................... ...- ............. :Tlii§.Permit Expires 1 Year From Date Issued 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:. i l.� n., . JOB ADDRESS/LOC ON .. � - { 1--8---- ------- > .{.� 1 �...........................CENSUS TRACT ••-• Owner's Name.... _- . L Phone .. Address 7 14._....... Cit �-- Zi - . -�--- ..-- ... Contractor's Name..- �-- - lsll�M :i'. ........License #.. -' r.t��{..Phone-..' Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ l� Motel ❑ 'Other-...... --------------- ---- Q f : Number of living units:...:...f-.------Number of bedrooms....�;Garbage Grinde-•_..,..Lot Size._.- ...... / ---------_........... ....... .. Water Supply: Public System and name......_Okf. ---- . Private 11 Character of soil to a depth of 3 feet: Sand ❑ Silt❑ ;Clay'[] Peat ❑ Sandy Loam E] 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 INSTALeATION: (No septic tank or seepage .pit permitted if blit se er is ov�liable within 290 feet,) P �'- III PACKAGE TREATMENT , [ ] SEPTIC TANK [ ] Size --.� Z/-- - - -Liquid Depth._- ------- ----- Capacity..:.42..0-0 22"IT ypef�/2�0 ,:..Materia!_'::20_!7�1vNo. compartments.-.-- -p.�---� Distance to nearest: Well..... -:-....Foundation./o . •. - Prop. Line...1/67.............C LEACHING LINE [ ] No. of Lines ..._.f...................Length °s each line...........,00of-- Total Length Q-t :.-....-.. .. D' Box.... ....Type Filter Material_ ._ Depth Filter Material._... ..L-- . `_i P of 2.:--------- Property Line...- ...... Distance to ne est: Well : Foundation . aa SEEPAGE PIT [ ] De th...p i ...Diameter----C?�_.....Number..-.: ...- �r Rock Filled Yes ❑ No E] f 10.a / I n . .: �., Water Table Depth--------- -- - - - ---------- ------------ Size.--- R�'---- ------------------------ Distance ------- ---•-Distance to nearest: Well--------------------'.--.---..---.--------..Foundation-....-,----f. .-....Prop. Line---1(9..___- 1 REPAIR/ADDITION (Prev. Sanitation Permit#....-,.:'--------------------------- ---------------Date----------..........:-...---.------.-.---.--.... Septic Tank (Specify Requirements)---- ....-.. - = = K �.--- '*y.........-- J ... Disposal Field (specify Requirements)....I.......... .....: ... ............. --------...---- .. ...-----------,•- - -..:•--`-...-------------� - --------------------------------------- (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 _ _ N 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.._.Ir-j. `D . !.....Own-er------ ------- ----- --------. By.... -------------- ----------- Title i (If other t an owner) FOR DEPARTMET LI E ONLY APPLICATION ACCEPTED BY------- -- ... ----._ ...... ...---- ------....DATE ... ° ............... DIVISION OF LAND NUMBER..... . -DATE -..-- ... c 'l DATE..._ �? r .. . _.. ..ADDITIONAL COMMENTS.......... . = -------- ......... 1 3 � ---------------- ....... ... .... ----------- ---- Final Inspe;;fion by: �� - -- -- --------Date.......v. . � EH 13 24 ( AN JOAQUIN LOCAL HEALTH DISTRICT ras 21677 REV. 7/76 3M