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FOR OFFICE USE: . _ ` FOR OFFICE USE: _ICATION FOR SANITAf1ON PERMIT ------------------------- ------ ----- Permit No 7------------ (Complete �n Triplicate) --------------------------- -------------------- - -- ' Date Issued-_7.n2_ '. '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. k This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: _ JOB ADDRESS/LOCATION r - . �- ---- CENSUS TRACT. ---------- Owner's Name .- Phone - d Address j r�0 �� . ,: ------------city. l� ----------- --------- -----Zip------------------ ----------- Contractor's Name-- - 0-/0410_ - . --------- -- ------------------------------------ License #._ _ / � ------Phone---- -- --------------- Installation will. serve: Residence ❑ Apartment House❑ Commercial ❑ Trailer Court ❑ ; Motel ❑ Other--------------------- --=--------------------- NuImber 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 ❑ Sandy Loam ❑ Clay Loam ❑ 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 seepage pit permitted if public sewer is available within 200 feet,) r i PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size-----------------------------------------------------------Liquid Depth.----------------------- Capacity-- ------Capacity-- ---- ----------- Type---- --=- -- --Material--------------------------No. Compartments---------------------- ----- -Distance to nearest: Well-- ----------------------- -Foundation-------------- -=--------Prop. Line----------------=------_ --- t ' LEACHING LINE [ ] No. of Lines------ .-•_..---------------------Length. of each line---.------- ----------.Total Length-------,--.,.=:-------------------------- I D' Box------------Type Filter Material---------------------Depth Filter Material------------- -------------------------------`------------- -- Distanceto nearest: Well----------------------------Foundation-----------.-----------------Property Line------------------------------------- SEEPAGE PIT [ ] Depth---=---- -Diameter--------------- ----Number----------.-------.------------------------------------ Rock Filled Yes ❑ No ❑Q WaterTable.Depth-----------------=---------------------------------- ----Rock Size-------------------- -------------------------- d -----.Foundation-------------- --- - --- -Pro Distance to nearest: WelL__________-----------------------__ - P• Line--- ------- -- REPAIR/ADDITION-(Prev. Sanitation Permit#-----------------------------------------------------Date.--------------------------------=------------) Septic Tank (Specify Requirements)--------------- --------=-.------------ ---- _ ,= f ------- Disposal Field (Specify Requirements)---- - -------. ---- = -- - `'-------- # t� ----------------------- ------------------ ----------------- -- ----------------- Yrequired addition on reverse side) I herebycertify that 1 have prepared thiisapplcation and that work willbedoe 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, 1 shall not employ any person in such manner gas to beco 1 bject toP man's Compensation laws of California." , y1 -------Owner Signed__ r --------Title----- -- ------------------------------------ ---------------- jif ------------ - - - {If other than owner) FOR DEPARTMENT USE ONLY d'L APPLICATION ACCEPTED BY-. ---------- DATE. 7 - DIVISION OF 'AND NUMBER------- ------------ ----..---.----- DATE------------ ------------------ :--------- ADDITION L COMMENTS------------ ---------------- ------------------------------------------ ------------------------------- - -------- ----------- --------------------- -- -- ------------- -- ----- ------- -- ------------------ --------------------------------------- X ------------------- -------------- -- ------ ------------- - ----- - -- ------------------------------------------------------ Final Inspection ------------ -----" -------Date-- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F85 21677 REV. 717