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F1 FOR OFFICE USE.. APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: •------------ ------ {Complete in Triplicate} Permit No.._.7 7-.0 �"Z -------- ----•- . F 77 ------ ------ 'This Permit Expires 1 Year From Date Issued Date Issued_...--..`- Fpplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe his application is made in compliance with Count Ordinance NRegulations- OB d t No. 549 and existing Rules and Regulations: OB ADDRESS/LOCATION...-.5�. �� • -------------CENSUS PTRACT_.. hvner's Name_. •---- ------ hone----- Address_..---_._l�/�---- � �... City --- -- •� ---------------------•----- Zip 'ontractor's Name._-. . - -------��-- -----•---- --- --- kLice'nse Phone one Installation will serve: Residence Apartment House❑ Commercial ❑ . Trailer Court ❑ f Motel. Other lumber of living units:___,_ ._.___-.-_Number ot`bedrooms..,-5--.Garbage Grinder------------Lot Size------ J Water Supply: Public System and name------ ------------------- -------------------- --------------- •-- .. I r - ---------•----••-•---._Private. :haracter of soil to a depth of 3 feet: Sonid ❑. Silt ElClay El Pea![-] Sandy Loam Clay Loam ❑ . Hardpan E] _ es Adobe❑ Fill Material------------ yes, type-------------------------------- Ilot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on,reverse side.] EW INSTALLATION: '(No septic tank or'; see , ge pit permitted if public sewer is available within 204 feet) PACKAGE TREATMENT [ ] SEPTIC TANK! ( Siz r . �- ---- ----- - ----------------Liquid Depth.--- -- �- ----------_- Capacity_X14 --__TYpe Materia{_, y- _-----No. Compartments.----- --------- ----•----` �- Distance to nearestr Well.-_-_____..��„�---__-__ _ !Q 1. --- ------ Foundation---------- ---------------Prop. Line------ ------- LEACH{NG LINE ( No. of Lines_:_____.._ ------- 3------- of each Iina._�_9r -_-•.dotal Length. r� D' Box.--_-'_='_'Type Filter.Materiol___, - _----.Depth Filter Material_._.___. __---------------------------------------------- Di sta nco -..-•.-- --_-Distance to nearest: Wei l_.-----,. U--l•------._Foundation------ -- ------------Property Line...... ._� .- •------------------ [ Depth -� .---X-�b__--Number----------r_._--_•--____-- Rock Filled Yes No. .� Water Table Depth,.--- ------- -----------------•--:--:hock Size_-•-� -'�- -•�.�---•------•---Line- Distance to nearest. WellF ___._____�4�- • `------ ---- ----Foundation: .___.Pr.op- _.._. _ ------ EPAIR/ADDITION (Prev. Sanitation Permit#________________________--------------- Septic _Septic Tank (Specify Requirements)______________ _________ - :'• . -•----------•----•- ------------- = ------ isposal Field(Specify Requirements)-------- �.... ------------------------- i ------------------ -------------------- ----------------------------------- ---------------------------------------- Phereby (Draw existing and required addition on.reverse side) certify that I have prepared this application and that the work will be" done in accordance with San Joaquin County Drdinances, State laws, and Rules and Regulations of the San Joaquin Local Health DistricF, Home owner or Licensed agents Fgnature certifies the following: (1certify that iii the performance of the work for which this permit is issued, ! shall not em to an person in such •o become subject to Workman s mpensation laws :of California.,, " y y p ch manner as Fgned- ------ -----. -Owner Y-----••-----•-- .......... -• Title_.- (I# other than owner) ------------------------------- 4��RPEPARTMENT USE ONLY kPPLICATION ACCEPTED BY--- - _ :._. -----•------ --- - - ---- DATE .. - ._ I VISION OF LAND NUMBER----_------------ ---•- - ----------------------------------- -------------•----------••--------------DATE: DDITIONAL COMMENTS.____._.__"._____._ I --------------- -----. -1------------------------------------------ ----- - --------------- -------------------------- Dated`-- 1.' 7 nal Inspection by:---•-- 1 Y._�� 1. �