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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 77 Permit No.----- - ............. - •--- (Complete in Triplicate) � 7� Date Issued------------------ .. ............. ................. t 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. lia ee with County Ordinance-No. 549 and existing Rules and Regulations: This application is made in comp JOB ADDRESS/LOCATION�.,.e -- L �l- . .....��- --- CENSUS TRACT �J Q;O. r �- _ - -- T.- _.-..Z:._i_ ---------- --- •• Pone --:---- Owner's Name.... �--�~...... �� "' � - -- Zip---. Address. ----- - ------------ - ---------- - [�r�. 7/ s -*4t '.7-- ... - �/ ...Phone.- -•--� •- ` ZO! - --------License # --- Contractor's Name._..- ..-�-�-�-- --- � � - --- --`---- - -Installation will serve` ❑Apartment House ❑ Commercial ❑ Trailer Court ❑ `f Residence Mote.Apart Other........ ---- Number of living units::..,.----..--Number of bedroom s_o�....Garbage Grinder_.1-------Lot Size ......... Private --------- -- ---- Water Supply: Public System an name.----------• Peat ❑ Sandy Loam ❑ Cla Loam Character of sail to a depth of 3 feet: Sand ❑ Silt El Clay ....... 1k E] Hardpan F) Adobe E] Fill Material-' _-- ....1f yes, type-•--------• - y ` buildings, etc. must be placed (Plot plan, showing size of lot, location of system -on reverse side.l in relation to wells, h NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 fest, ( e '-Liquid Depth._ = - SEPTIC TANK � 5ize.��..�� -_�-�" ---- . PACKAGE TREATMENT [ i . �y /^�, o- Com artments ----- ------------ -- Capacity.�IPL O-.---.TYpe>f�� _�-�l. Material.G. �� ` p� i Distance to nearest: Well-__-- ---�---- Foundation-- ..__.Prop. Line_.`�...."t-��f....... 'Length of each line.----�.D ._Total Length ....-_ _U4•_�.............. LEACHING LINE [ Na. of Lines....._.I----------- g �D' Box...._-_.,..Type Filter Material.---- ......:..... Depth Filter Material-------..----- ---;------ - A. ' ,. Distance to nearest: Well----- -� _ Foundation--- ........... ....Property Line..__.-- wRock Filled Yes �!No El SEEPAGE PIT (• Depth._ .-...---Diameter... -3 -_-... --Number ------ `. '.Water Table�Depth.------------------` ------ ---=-- Rock Size-- ----- ----- ------ -----------•-- F ---- Foundation'... _p--Line-------- ---- ---- Distance to nearest. Well-------------------- --- - " s ` - ................. ------ ( REPAIR/ADDITION.(Prev. Sanitation Permit#.-.----- ,. µ t -- ------- --- �° Septic Tank (Specify Requirements)_. - ---------------- r r •.......... Disposal "Field (Specify Requirements)- ----- •--- •----- -•----- _ -= _... ----- ---•----- w --•---•-- ------- ------ --- r ......................�` � Draw existing and required addition on reverseside) e fy that l have prepared this application and that the work will be .done in accordance with San Joaquin County I hereby•c - Ordinances, 5t6te Laws, and Rules and Regulations of the San Joaquin Loca'I Health District. Home owner or licensed agents signature certifies the following: 4 erson in such manner as "I certify that in the performance of the work for which this permit is issued, 1 shall not emp loy any p to become subiect to Wotkma 's Compensation laws of California." Owner Signed-_— ------------------- ----- ------ -- Title 6 (if other than owner) � �� _ FOR DEPARTMENT USE ONLY . -- " DATE _....f�:- .. APPLICATION ACCEPTED BY------- DATE _- ------•---- ----- . - DIVISION OF LAND NUMBER.'__-".--_- ------ -------- -- ---------- _.. _....--- ADDITIONAL COMMENTS �.�' r -_- ----- •--------- ------ - --------------- ......�::� .t- ....... ................... ---- -- . 1-Z-------3----"- --------- --- - ---Date. . - - --- -- Final-(nspecrian lay---------- --- - ---- - -- F&S 21677 REV.-' 7 SA JOAQUIN LOCAL HEALTH DISTRICT EH 13 24 r _