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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----- .....----`-- r -:.,.. --.. ._. _ Permit No... . .... . ) (Corpplete in Triplicate ... . .... II %- -_.__ � "1 . - This Permit Expires 1 Year From Date Issued 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/LO TION...�� ! .. _- CENSUS TRACT Owner's NameE f? /OoScsf� s4 3....,�yf1C..------------------------p--.-�--�------- ------------Phone-_.3,2.7-._-�-1�- Address . 1S."I" �e/..��.... ...... .... --------- ------..... . City J/._. �c1...------. ... ..Zip------------------------------ Contractor's Nome_L?-C...--j' T.l�-.. � '� License # 3pS7-.;V.._.Phone-._c;F41!. Installation will serve: Residence ❑ Apartment Hous`�Qommercial�Trailer Court E]Motel E] Other Com+ Number of living units: - . -. Number of bedrooms. .. . - Garbage Grinder _.Lot Size. ..................... Water Supply: Public System and name ................................. ----- ......._.......... . -- -- ---------•----........ ...................... ....Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat F,, Sandy Loam ❑ Clay LoamU;1— 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 seep ge pit permitted if public sewer is avai�l;le within 200 feet,) t/ PACKAGE TREATMENT [ ] SEPTIC TANK [� Size-..._. /F' /�. 9 -'____L_.-'''j._Liquid Depth - ._..... ..... CopacityA460g01-Type .._...__.Material a,00------------No. Compartments .21................ ... Distance to nearest: Well..... ----- �y/ a' ------------------Foundation. ---.--------___----..Prop. Line... .. . ._-----...._. LEACHING LINE *14, / p.............. (A.}- No. of Lines ..-..__-.-.Length//of__ each line------ ------ ------ Length _..__-.-__. __. ._ 'D' Box /y.Type Filter Material.L.�"7 ��4.Depth Filter Material.- "_ !?.1---------------------------................._.. Distance to nearest: Well...A-RD�-_....... Foundation . r—,.e) r Property Line.. .15-414.0 SEEPAGE PIT Depth s t .Diameter ..-.Number . . ...2-- Rock Filled Yes�.iNo E] / --/1/A. Water Table Depth _ Rock Size . ... . _. .. . ..- Distance to nearest: Well ..... -------------------Foundation.-_,75_7!_..__.....Prop. Line.. .S� / REPAIR/ADDITION (Prev. Sanitation Permit# - _ ___... _. _. Date Septic Tank (Specify Requirements) _-.__.... Disposal Field (Specify Requirements) ........ . . ..........I............... - .. .... .....--- ----- ----- - - - _ ..---- -----..... -- ...I---------...-.......................................__-• _..-... ....... ...... --- - ---- .. . -. . ........... ---------I............ ................ ................................................................. (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 subject to Workman's Compensation laws of California." Signed. .... . _ .*_._ _ _ _ - - Owner �j ,.C:/ le By h�� . - ----- ---- ------- ._..___. .Title.-.�LQ.t1� �- 1 ( an owner) FOR DEPARTMENT U ONLY PPLICATION ACCEPTED BY __-..-. . DATE _. .-.�- -- '.� - DIVISION OF LAND NUMBER ............................. ............ .. . . ....DATE ......................................... ADDITIONAL COMMENTS_.............. ..................--.............................................................. ......................................................_...... .. ---- ------------•-----•--•---------••-•----•.--•-----------------------------................_..............------------....-------------------------------------.......................................... .................................................... -- ".. ------------------------------•• --- -------- --- _. . ... ---------------..-----..... - Final Inspection by:..... --- ---- - -- ------------------Date....._ . _�. ... ... . .._ EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV.7/76 3M