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FOR OFFICE USE: FOR OFFICE USE: I APPLICATION FOR SANITATION PERMIT ------ Triplicate) Permit No.7-r`_��-- ------------------------------------------------ (Complete in -------------------------------------------------------- hate Issued-__ This 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 County Ordinance No. 549 and existing Rules and Regulations: � � --------CENSUS .TRACT.---- - ------- JOB ADDRESS/LOCATION--------- -- ----- --- t .1 Owner s Name-..___--�-��' -- --��`-`�--- ------------ -------- ---------------------- ---------- ----- ---- Phone------------------------------- ----- Address--.. City ------------------ ------Zip--------- --------- ----- Y ! �__7 / ---- one----- -------------------------- Contractor's Name.-" '- -r / JG-¢ License v d Installation will serve: Residences( Apartment House.❑ Commercial ❑ Trailer Court ❑,�.�� I - Motel ❑ Other------------------'------------------ ------- Number of living units:- 4-._--.-_Number of bedrooms -_-Garbage Grinder, -_----____Lot Size-----------------------------�-- ----------------- �. Private Water Supply: Public System and name-------------------------= ------------------- y f ' Character of soil to a depth of 3 feet: Sand ❑ Slit❑ 'Clay ❑ Peat❑ - ;'Sandy Loam❑ Clay Loam ; r Hardpan ❑ Adobe❑ Fill Material--.--_------If Yes, type----------------------------- (Plot ---------------------------(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) t;l� i ANEW INSTALLATION: (No septic tank or see age pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT I ] SEPTIC TANK [� Size-�'__ -------------- -_� ___________________.__- Liquid Depth.----- -___- ----------- _e'15Capacity-166- - Material--- ---_"L ----No. Compartments---- ------------------- -------------- ----- - Type-- -------------- -- - - - --- . Dist6nce to nearest: Well---; ------� .a--fY- ---------------Foundation-- tb- .Prop. Line:, ---=--- I , LEACHING LINE; [: No. of Lines-=-- 3---------`---- Length of each Iina.------- -- ----,---Total Length ----- - -Q- ------------- D' Box- 1------Type Filter Material------- - ----Depth Filter Material-------Iq---------------------------------------------= f Distance to nearest: We11__-.-�_� _ - -- - Property-=- --- - -Foundation --- - >� ---.Pro er Line -----'��--�---------- ---'---.I I `� SEEPAGE PIT Depth-__� .�_�riameter-.- r� -_____Number------------- ------------- Rock Filled Yes No ❑ Water Table Depth------------- ------------------------------ Rock Size----- , --------------------- . '� 1�� p. Line-_3---- - -- - Distance to nearest: We11----_�-_-_----- ---_----------------Foundation.___. -- .- _ -----.Pro —L-17 Distance (Prev. Sanitation Permit#-_.___-------;----------------------------------Date-_--- .--___.-------------------------------- Septic _----_----,------------------Septic Tank (Specify Requirements)-- --- -------=-------- --------------------- ------------------ ------------ Disposal Field (Specify Requirements)------------------ ------------------------ f, +- # _ ----------------------------------------------------- - ---_---- ____--_--- - ----------- ---------------' ------------------------------------------------------------------- (Drawe''isting and required addition on reverse side) 1 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: Y _ _ "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 Compens tion laws of California." Signed------------------ -------------- ------------- ------- Owner a i BY------- ------------------------------ -- - - - ------ ltle t --------------- -------- (If other than owner) FOR DEPARTMENT USE ONLY' gg j APPLICATION ACCEPTED BY - = - ------------- DATE.-� 2= 4 DIVISION OF LAND NUMBER-------------- -------- -- --------------------------------------------------------------- -- ---------.DATE--- --- ---- ---------------------------- ---- ADDITIONALCOMMENTS------- ----------- ------------------ --------- ------------------ ------------ -------- --------------------------------------------------- ---------------------------- -------------------- ------------- Final-Ins ection,b -_ -/3 "-- -l/.� --- - -- ---:--_-ry=--- '--------- -------------- ------------- -- --Date- -.,O J------- ----- ---------- F&s 216T REV. 7/76 3M EH 13 24 A JOAQUIN LOCAL HEALTH DISTRICT