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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �Jc7 Permit No. J (Complete in Triplicate --.------- .- l-_I Date Issued_y�'ZL-7� ... 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: JOB ADDRESS/LO TION /��.__�' � ........... CENSUS TRACT 1��-r+ra c" 'cu Phone ............... Owner's Name ..0 .... ........ ............ .. " Address Cit ip.- �. - - -o .. License ..3.r k Phone. -._. Contractor's Name. .-.._ l---- "" ....J " Installation will serve: Residence [!( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other. .. Number of living units: ----/..... Number of bedrooms �. Garbage Grinder.... ....Lot Size-.. .Private � Water Supply: Public System and name. - Character of soil to a depth of 3 feet: Sand ❑ ilt ❑ Clay ❑ Peat F-1SandyLoam ❑ Clay Loam E-.Hardpan E] Adobe �el`IIIMaterial_ _ 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 see age pit permitted if publicewer is available within 200 feet,) 1 Size-.. �� - t5 ..-_ Liquid Depth PACKAGE TREATMENT [ ] SEPTIC TANK [ ------ v _.Material._A. No. Compartments --•- - •---- Capacity -�.�'n- - Type _ Distance-to nearest: WEll...t..__�.c c..�,,i ------ Fou ndation ......�-°--L.r - . Prop. Line.._. -.5-- r LEACHING LINE [ ] No. of Lines - _ .._ Length of each lin .. e . � .1"{•-�- Total Length . L ,.-G_�.._.__.. . .. . .................. 'D' Box. Type Filter Material .--.� Depth Filter Material..... r - -- L Distance to nearest: Well t,.- Foundation........i_E .. -.=----Property Line .. Z--------- ---- Rock Filled Yes [PJ No❑ SEEPAGE PIT [� Depth ..X S�'�Diometer...__-�� .-.- Number... � „ - Water Table Deptk...... ....�.e-� . -- Distance to nearest: Well...... .. Rock Size _ �ya_X.� .- -- .- - - ............ ...Foundation ._ 47 Prop. Line -�-J.-�- REPAIR/ADDITION (Prev. Sanitation Permit#... .... _...... . .... . . ..... . . .Date... _ ) Septic Tank (Specify Requirements) Disposal Field (Specify Requirements)_ - -- (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: "1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed Owner f-U /� Title (If other than owner) FOR DEPARTMENT USE ONLY -- --- .... DATE - —-------- ------- - -- APPLICATION ACCEPTED BY __ -- - - - -"""""--"-•-'--'�-" - DIVISION OF LAND NUMBER ...-•--_.... . .................................... DATE........................................... _. ADDITIONALCOMMENTS ...............-•--............................................................................................................... ...........-•-....... ..... - ..................•-._........._....---_....._....-- ............._..._ ................ ....................... ............. ......•"........... _- , ......:_....s.___..... -.._.. _ ....--•----_.---.------ -..-.-.._...---- ----- ..-.._.__-----. •------- -- Dote / j ... Final Inspection by: ._...C..,�.1� ._ . -- - Fh5 21677 REV.7176 3M EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT