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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 70 ----- - ------ ---------- -------------------- Permit No.-.7- - ------- (Complete in Triplicate) ---------------------------------- �3 7 7 --- ------ - Date Issued---- --- -d_------ 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/LOC TION..--- -_--_ - ...--.- � 't/y� --- / �. �-- Z2 -----------Phone ---!------- Owner's Nameytd S60 - l Address -----------1__Z 1� ------5444-. I ----- --- ---- ... . ------- City :. Zip --- Contractor's Name-------- (;?i�7't-------- ---1r_1"l-7a---- ----------License # 1_15F _PHone-#..3------- --------------- Z i Installation will serve: Residence, i Apartment House ❑ Commercial E] Trailer Court E] ' Motel ❑ Other---------------- ----------------------------- # Number of living.units----------- of. bedrooms----.-_---._.Garbage Grinde.r..._.___._----Lot'Size................:................... Water Supply: Public System and name------- ---------- ------F ------------.-_-----------:------=------------•-- ---------------------- =--------------------------- ___Private Character of soil to a depth of 3 feet: Sand ❑ -Silt ❑ Clay ❑ Peat❑ Sandy Loam Q Clay Loam ❑ Hardpan❑ Adobe ❑ Fill Material_.._-.------If yes, type-------------------------- ---- (Plot plan, showing size of lot, location of system in relation to welis, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet, ) + -" - PACKAGE TREATMENT [ ']� �' SEPTIC TANK [�] r Size---------.-----------------------=--- ---------- Liquid'Depth- -------------- - ---- Capacity---- '------ ------ TYPe------ Material--- --------------- = ---No. Compartments--------1----- ---- ` Distance.to nearest. Well ----------------------------------Foundation '----------- -- Prop. Line_= LEACHING LINE. ( ] No. of Lines--------.=--- ----------------Length_of each line-- ----------- --.Total Length.--,_--------- --------------------- 'D' Box........----Type Filter Material--------------------Depth Filter Material.......______-_.-..----------_-.....__------ --- ----,- Distance to nearest: Well........=-------------------Foundation---_--------------------------Property Line--------------------- --------- SEEPAGE PIT [ ] s Depth----------------Diameter_ -..__-_.... ...Number_-___._..-..----:--____-------- Rock Filled Yes ❑ No ❑ £ Water Table Depth--------------------------------------------------------- Rock Size.------------------------------------------------ - Disfance to nearest: Well--------------------------------------- ---Foundation-----------------------------Prop. Line.- ------------------------- REPAIR/ADDITION-(Prev. Sanitation•Permit#------------- ---- '---=----------Da e------------/- -----_---- -=--=----------) _ 10 . Septic Tank (Specify Requirements).---- .._-.-_ - Disposal Field (Specify Requirements)------ -- -- -------- -- -/ ------- �d> / � --- - ------- ----------------- v --------------------- ----------------- (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 ! "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 Compensation laws .of California." Signed ------- - - - :Owner .. - . 1 X i BY -r 'fes -- --- ------ Title _: - - --------- -- - , f ' (If of er than owner) c FOR DEPART ENT USE ONLY APPLICATION ACCEPTED BY---.- ' ---------- ---------------------------=---DATE.---- -- ----- 7.7-----� DIVISION OF LAND NUMBER. = -- - - DATE ' -- -- . ADDITIONALCOMMENTS------------ ------------ ------------------------------------- ----------------------- ----- ----------------- ----------------------- ------------------ 1 . ---- ------------------------------- --- ------ -- -- - - ---- = Final Ins spec b �_ -- ---- -- - --- ---- ------ ------------------_----- Date..--- r� 1�.�� P y;_r_. EM is 24 SAN JOAQUIN LOCAL HEALTH DISTRICT f&5 21677 REV. 7/76 3! k '