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yY----war_�-•_.:.'.� _a�_ FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �/�� t Permit No..��'.-............ (Complete in Triplicate .......... Date lssued '.: .. '7 .--... � 1 This Permit Expires l Year From Date Issued Application is hereby made to the San Joaquin Local Health District forAa permit to•construct''arnd-install the work herein described. p This application is made in compliance County Ordinance No.544 and existing'Rules and Regulations: Id6I ----•-------- --------.CENSUS TRACT...--- -------------- JOB ADDRESS/LOCATION........ -.- .- -------• t Phone---- ------ -------•-- - Owner's Name.... . - - --------- --- - ------- - --- -- =-- --- --- ------------ ---_--_--------------------------- --------•------ .... City ---- : .. Zip-. . • Address----...--- .. .. --- ---" .....:........�--- -------,.-..- -- • .. -- f License #---- . /._Phone.f.. ,1 �� .. ....... Contractor's Name........-/-'j-1 - - -• "..... . ... . . . . . Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ MOW ❑ Other... ------ - -- ------------------------ .../-.--Number of bedrooms_ -....Garbage.Grinder....--------LotrSize.. - Number of living units:..... - _..� _ .Private ----------------------------------------- -------- "Character of soil to a depth of 3 feet; Sand ❑ Silt Water Supply: System Sand Loam Clay Loam ❑ Clay ❑ Peat ❑ Y. ❑ y 1 _... . i Hardpan ❑ lAdobe ❑ Fill Material.. I.. _...lf yes, type------------ Ybuildings, etc.-must be placed on reverse side.) (Plot plan, showing size of lot, location of system in relation to wells, 1"114- NEW INSTALLATION: (No septic tank or seepage it permitted if public sews is available within 200 feet,) t l Size." ------ --------------_------------ M - ----- .• Liquid Depth.-._:.-...._...---- ��-"--� TREATMENT j l SEPTIC TAMC 13 ------_-•-------- Ca acit Type Material..... ------------No. compartments......_------ -------•------- ----- PACKAGE p Y" .... :- - ---- . Distance to nearest: Well-------------------- ----- ----- ---Foundation......-.-- - ----:,.. Prop. Line------ LEACHING LINE [ l No. of Lines.— .............- e Length.of each lin .-----"- -------- Total Length -------------- .......... i ....---. ..." ......... ` 'D' Box.-........t Type Filter Material------ . ---------- Depth Filter Material-" -------- E Iaresfi: Well.................. . ...... Foundation Property Line_.. -----..... Distance to ne . Number---- Rock Filled Yes ❑ No❑ SEEPAGE PIT [ 1 Depth-'-.-.. ...Diameter...--.... .. ... - t Y� .. --------':�_-:Rock-Size--- --------------- Water Table•-Depth.----��-"---._-�--•----"- ------- ---- -- I -.Prop. Line ----------- ----- ---------------Foundation. Distance to nearest: Well.......................... . � A . ....Date..:..................... ----".......... ) REPAIR/ADDITION (Prev. Sanitation Permit#.......... -- ...- -- I Septic Tank (Specify Requirementsl...._;..-----------------------� ------ - ------y - ----• Disposal Field (Specify Requirements)--..� ----- q.�. 0-714- --- - --------------------------- ----------------- �. --- I. ------- ---------- (Draw existing and required addition an reverse side) be done in accordance with San Joaquin County owner or licensed agents I hereby certify that I have prepared this application and that the work will Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home I signature certifies the following: person in such manner as. "I. certify that in the performance of the work_for which this permit is issued,-.t�shall not employ any to become subject--to Workman's Compensation laws of California." w. ` ..Owner Signed_ i -- ....... --------------- --- --- Title 4 (if other than owner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- DATE DIVISION OF LAND NUMBER...................... ........ ------ ADDITIONAL COMMENTS-------------- ------ ---- - ---- --------------- - ............••......... ................... ------- . .. ------; .... .....---••-...---••............... . � ----� •- ate. -� -- " -- --- � ... ...... Final Inspecrion b -------- ---------- --------y:-. - ---- . " F&S 21677 REV. 7/76 3N EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT