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L FOR OFFICE USE: In< FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -- ----- - / .E7---------- Permit No.2 7- SZ 7 (Complete in Triplicate) --- ------ --'-------- Date Issued._�'lfL.7.7 --------------------------.__---_-._._._._----- 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. -his application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOBADDRESS/LOCATION --------- ---------------------------------------------CENSUS TRACT.-------------------------- Jwner's Name-,-- ----- --------------------- - 6 -- q �• r address-- ----- .. ! �a C �� ! . Ef el �-_...... -- City-- c4?kTp ry------------ Zip----- -------------- ^ontractor's Name..- �__i__/Z} ,- / �� 7�/`)�' �5:l ..-- Ja F_ tt License #°'zf�sj J..._.Phone---44(6] ...- ... Listallation will serve: Residence Apartment House[] Cgmmercial ❑ Trailer Court ❑ Motel ❑ Other_L ` g :...- _.umber of livinunits --------Number bedrooms_ Garbage Grinder__-__--- $Lot ize_- - _. ___,)L.�_ fi. .__ _ ..._..------umer o _ / J lumber Supply: Public System and name---......--------------------------------------- --1 -� !"R' --- ------------- --------------------Private ❑ Character of soil to a depth of 3 feet: Sand El Slit❑ Clay [a Peat ❑ 56ndy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material'.__._ If yes, type-------- _-__---_--.._...- V (Plot Plan, showing size of lot, location of system in relation to wells, buildings,etc. must be placed on reverse side.) • / 'W INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) / 00 6.�CKAGE TREATMENT [ ] SEPTIC TANK [ I Size___.............._..-___---------.-..-___.------Liquid Depth---- ------___-.------�,/ Capacity-----------------Type------------------Material--------------------No. Compartments----------------------------b Distance to nearest: Well ----------------------------Foundation------- --------------_--Prop. Line--------------------------- L-ACHING LINE I 1 No. of Lines------------------- Length of each line-----------------------------Total Length_................_______.-__. 1 O 'D' Box------------Type Filter Material---.----------------Depth Filter Material -----------------------� �. Distance to nearest: Well_ ------- --------- -------Foundation----------------------------Property Line 9 iEEPAGE PIT [ ] Depth...:------------Diameter.------- _...Number Rock Filled Yes ❑ No ❑ Water Table Depth----------- -- Rock Size- --------------------------- ------- Distance to nearest: Well---.------- -------------------------------.Foundation--------- .__......Prop, Line- 'EpA1R/ADDITION (Prev. Sanitation Permit#- --------- ------ -------- -------Date-------. -----------------_-_---------------) 1 tic Tank (Specify Requirements) 1 )isposal Field (Specify Requirements).._....... -- ------------------- -- '- ---r1--- -- --- ---- - - --- --- ---------------------- - - -------- ---- -------'----- --------- ----------------------------------------------------------------------- ----------- ---. - - ----- (Draw existing and required addition on reverse side) II reby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County 41.nances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents gnature certifies the following: arfify that in the perfor nee of the work for which this permit is issued, I shall not employ any person in such manner as L,ecome subject t / n's Co's laws o al' omia.,. gned.-------1�3 �� G'� - -R - ---Owner Title (If other than owner) � _ FOR DEPARTMENT USE ONLY JCATION ACCEPTED BY---------- - ----- - - - --- -------------------------------------._----DATE..--_.711,,'e1';7� - -_f--------------- ION OF LAND NUMBER._. -- -- --------- ----- -------- --- ------- - ... DATE.---- -------- )DITIONAL COMMENTS._------- -------------------—--------- Inspection by-------- - -'--- - - -Date.__ -1-0--. ..?- --------- 4 - -D - - --- - ------ -- Fbs 2169] REV. ]/]6 3M SAN JOACIUIN LOCAL HEALTH DISTRICT