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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERA., - .. (Complete in Triplicate) Permit .:.......... ........... ------ Date Issued. 5y.�/..�'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. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ../.1?,C.T L�.,(j//-(- -/�,�,.-Ld�/�' _ V- L)_CENSUS TRACT.................. ............. Owner's Name ......... ..... ...... .. ......... ...... . . ....... ... Phone 3.�-` .--/. Add ress..`�/`E . .... City_........ .. .. ..•--•.... _ --------Zip----•-• --------- ---------•-- Contractor's NameG`J. ,N)—dP, .............................................. ........License # --•• ------•-•--- Phone------ ---- -----_ ------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other . _ CL Number of living units: Number of bedrooms..:.. Garbage Grinder S...Lot Size---1!-?-e 7 y ............. Water Supply: Public System and name.. ......---------_-..................... ... ..... _- ----- .____-_...___--__Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam( 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 INSTALLATION: (No septic tank or seepage pit permitted i public sewer isPvailable within 200 feet,) / PACKAGE TREATMENT J nj ( I SEPTIC TANK �J ize_.. - !l F---- ---(�p Liquid Depth. - ... O Capacity.TZ �� , TYpe. .-v'tZ .....Material_ ._ �Y.1"No. Compartments_.._._ 2----------------- ----- Distance to nearest: Well__._.. ....... .....................Foundation. _/_G)..__... _ Prop. Line.....S...........- LEACHING LINE { No. of Lines Tl` _.._.._.__. g �.C>------- -- 9!/ / ..__.Len �th �iehhline.-.__. - _Total Len th _. __y.�.__.._.............'D' Box ...Type Filter MaterialDepth Filter Material........�..�............... ._.__. �--...__-.....---- Distance to nearest: Well__ ........ Foundation_.__1-.d.,.............Property Line...-----------.-------- -- SEEPAGE PIT Depth.. a S . Diameter-.--3..3...'._..Number .------eke---__...___._ Rock Filled Yesd No Water Table Depth---------------- -------.Rock Size-----------..._ Distance to nearest: Well--. ----- -----------------.... .....Foundation_ ._.._.._ _ Prop. Line.. ..__. . . . REPAIR/ADDITION (Prev. Sanitation Permit#--_ -------------------- - -- -Date_...__... .------.--------------------...) Septic Tank (Specify Requirements)._ _ .._ Disposal Field (Specify Requirements) _ ------------•-- .__........... - ---- ----- ------ --...... . - ---•------------------ --------------- -- ------ --- ----- - ------------ - - (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 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 subjVt man's Compensation laws of California." Owner JSigned`.!/ Title - (If other than owner) ' FOR DEPARTMENT USE ONLY17 (*� APPLICATION ACCEPTED BY ---------------------DATE .. - d DIVISION OF LAND NUMBER...... ..-... . --•---..--•------ -----------------DATE---------_ -- ---•---- - ..-----•-- ADDITIONAL COMMENTS...----•------------------- ---------- -- .... ----.----- •----- ..- . - - • - Date.. - ----- -------------------------- Final Inspection b EH 13 24 SAN JOAQUIN LO L HEALTH DISTRICT F85 21677 REV. 7/76 3M