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fi . FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � ---------------------- --------------- --------------- Permit No._�7—__3__ 2,6 - {Complete in Triplicate) ---� ------------ � --------- - ------------- This Permit Expires 1 Year-From Date Issued s 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 Regulati:o_n"s: _ x I . JOB ADDRESS/LOCATION-----d--7-5`7.__..._ -- -------•--------- ---------- ----------------._.CENSUS TRACT F 6 Owner's Name. ---=------------------- --------------- ---------------_ _ c _ = .rl� ! t 7 y{� i Address-- ---- -- - --------------------I----------- - ! E - -- Z i . �A p �' Con#ractor's Name____. .__._ u -----Lice #---�-..- '- f- _Phone_, , -y�g -'---. Installation will serve: Residence; Apartment House ❑ Commercial Trailer Court ❑ ' t. Motel .❑ 4Other._.:_.. ------------------------ Number of living units:----. Number.of.bedrooms.._. 3-..Garba-ge Grinder .--.Lot Size_ ..: 'JZ CL -'------------------ Private ------ - ------ --- i Private Water Supply: Public System and name--_-= . ---------- - _- ------ �..: Character of soil to a depth of 3 feet: Sand r `Silt❑ Clay ❑ at ❑ Sandy Loam b Clay Loan), Hardpan ❑ Adobe ❑ Fill Materidlr--=-----_If yes, type-------------------------------- t _ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be'p€aced on reverse side.) NEW"INSTALLATION- - (No septic tank or seepage pi4 permitted if public seweris available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK - [j]" Size---------- ----- - s-----"------ ------ --------Liquid Depth.------------------------ J i Capacity/,� '-0-------!Type- _--Material----a-..0 No. Compartments.------Z.w..___-._--------- ti ---------------Prop. Line--------------- - Distance to nearest: Well--.--=_-'------------------------------------Foundation:----Via- LEACHING LINE [ ] No, of Lines--__..._p'"1..-e.,____ -._._.Length of each line.:__:` '� _.______:.,.__:Total Length,,-_._l._7.__-----------------,_.- f -_ _ = " I ' Foundation -- Pro Barest: Well- ------ -------- -----Fou D' Box-'`Type Fiater Material.,____ -_-_ ____ Depth Filter Ma�ial-.:__� __� - 'Distance to ri: _ - •: - - e------- � -- ----- ------- t ... � --- � perry Line-_! . SEEPAGE PIT [ Dep#h___ab.�---Diameter------3-3.__`----Number--->---- -----------:--- Rock Filled Yes ' No s Water Table Depth------------------------------------------- ------------Rock Size l -- ---- ��11 Foundation } Pro Line--------------------------- Distance to nearest: Well.?--------------'----------------------------- P- ., . . REPAIR/ADDITION (Prev. Sanitation Permit#-` ----------------- -------='-------------.Date------ - -------------------------------------- Septic ---------------------------- ------Septic Tank (Specify Requirements)-------- --=--- --- --- -------------------'---------=-------------=----------=-------------------------------------- ---------------- -------- Disposal Field {Specify Requirements) -------------- -------------------------------------- -------------------------- -------------------------------- - -- ----------------- -- ---- - ---------------I------- -- ---- --- ---- --------------------- ----- --- ----------- - = -- ---------- --- ------- ---- (Draw existing and required addition on reverse side) I hereby certify that I have-prepared this application and that the work will be clone-in accordance with San Joaquin County OrdinanCL-S,r State Laws, and Rules and Regulations of'the San Joaquin Local Health District. Home owner or licensed agents signature certifies the following: i I "I certify that in, the performance'offthe 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.',' .. . ------------------ -------------------- nerSigned- :-------- - --=----- -_---: --- ---.------ - =Title --- --- ---------- (if - =- (If , other-than er) - FORD ARTMENT USE ONLY ' --------- DATE... ..` . ----- ------ APPLICATION ACCEPTED BY------- - - ----------------- ---------- ---- --------------- - DIVISION OF LAND NUMBER DATE - - ------ = ADDITIONAL COMMENTS----------- ----- - b. t -. . - ------------------ t -------------- - -------- 1 t-- --- ------ -- ------ --------- ---- --- ----- -- ---------------- - - ------ '" Final Inspection by: -��' �, . ----------------------------------------- --------------- --Date."_ _ - t EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT ras z1a�� REV. �/�6 3M I