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r FOR OFFICE USE: FOR OFFICE USE:, APPLICATION FOR SANITATION PERMIT --- /5/G3 Permit No.7 -------------- ------- --------- --------------------------- --- (Complete in`Triplicatel Exp--- Date Is _ ___ ___________ sued _ This Permit Ex fires l Year From Date Issued I Application is hereby made to the San Joaquin Local Health DisNo. 5or and existing t to construct and Regulations:and.install the work herein described. This application is made in compliance with County Ordo `A k -------------` --_------- ,. - ,___-. TRACT - :--- : ------ Phone- ------------------- CENSUS JOB ADDRESS/LOCA 101V. 1 -- -- :--- 0 , Owner's Name. '- "�` '- .. P _ - Address. a ,E --------- ---------- LicensePhone Contractor's Name-1---- - --- ---- ------ # � n Instal lcit.ion will' serve: Residence Apartment House ❑ Commercial Trailer Court /❑ i Motel Other.-17)f Loe /t Siz -- f i f living unit : - �- Number of.bedrooms Number os= --- --Private F Water Supply: Public System?and name-_-;------------------- --- �,/ Character of soil to a depth of 3 feet: Sand [] 'Silt El -Clay ElPeat❑ Sandy Loam EK Clay Loam l Fill Material_- - --.-If Yes, type t Hardpan ❑ Adobe ❑ (Plot plan, showing size of lot, location of system ;n relation to wells, buildings, etc. must be placed on reverse side.) ..r.- -, y NEW INSTALLATION.' =(No septic tank'or see age 'pit permitted�f/�pu�tic sewer is available within 200 feet,] } PACKAGE TREATMENT [ ] SEPTIC TANK [7 Size_-qi/_ -------------------------------- Depth= - --------- Capacity..._ d O, .Type- - Material-_. l/ "�$----No. Compartments-F----- "- } U - ---.-Pro Line- '�--------- ---------- -Distance,to.nearest, Wel! ;_ � r---- Foundation-- p --r -- =�,. LEACHING LINE. L/!_ .No. 'of L'ines_.._. _--,:,`-W�' :.Length of.each line.- � Length.__ -16 --- --- i _.,- ,-.-.-..Total 'P ! --------------- T D' ox. f;.----..Type Filter Material._-.5R------Depth Filter.Material-- ---T - - L . % Distancsto nearest: We1L._�� ___;------`--_-.Foundation"-_ -4_-_•-=------=---.Property me- _5- ---------- y `t �.- Ye N ! Roc ll SEEPAGE PIT [ ] P -" - De th = Diameter Number----------- kFi Filled, s ❑ No[I Water Table:Depth-- ----_. c = -------- F d -------------------- 1 Distance to nearest: Well_----------------------------_ -- -- oun" ation--------- -- ..Prop. Line = ... _ .. :---- -------Date:--��»•.T� ------- � -- ] ---------- REPAIR/ADDITION (Prey:Sanitation Permit#-:_------:"--_-__--- -- � , i ------------- ---- ---- --------- Septic Tank (Specify :Requirements)Requirements)__:_--- _.____-- :------- -- -----------,------- ---------- t x i --------------- ------------ Disposal Field (Specify Requirements)-___"- --------------- .-- -------- --------------------------- ------ - �. ----------- t I ---------------------- {�(Draw w existing and required addition on reverse side] I hereby certify that I have prepared this application and that the .work will be done iri-District. accordance wome owne°orJlicensed agenoaquin- ts Ordinances,' State Laws, and Rules and- Sign nd Regulations of the San Joaquin Local Health D s signature certifies the following: E i "I certify that iri the perfoFinance of the.work for which this permit is issued, 1 shall not employ any person in such manner as to become subject. to Work Compensation laws of California." Owner Signed --- --- .. . i - . - Title -------- -- --- ------ &e - ------ BY- ----- ------------------------ (if other than'owner] { FOR DEPARTMENT USE ONLY DATE APPLICATION ACCEPTED BY -- ------- --- DA TE - DIVISION OF LAND NUMBER-------- -----=--- --- -- ---- ------------------------- -- ------ --. :--.-------- ADDITIONAL COMMENTS----------------- ---- --------------------------------------- - --------------------- --- . -- --------------------------- -------- ------------ ----------------- ------------------- ---------------------- ---------------------------- --- ----- -- -------------------------- # - _ ae " Final Ins ection:b p Y' ``� - — F&5 21677 REV, 7/75 3M .fN 13 24 SAN JOAQUIN CAL HEALTH DISTRICT