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FOR OFFICE= U51=: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No....7.f.^ 7" ........ ... ........................ •------- (Complete in Triplicates Date Issued...f�:. _.", This Permit Expires 1 Year From Date.Issued Application is hereby made to.the San Joaquin Local He lalo t D District for a permit to construct ancl,install the work herein described. This application is made in compliance with County Ordinance�No. 49 and existing Rules and Regulations: .� CENSUS TRACT------------------ ------ JOB ADDRESS/LOCATION...... 'J Owner's Name.....-.r.t.l Phone... ._. ..... > --..._ /.......__... .. : _..- ..-i.....__.. City--------- ---- --- -----..------ ------ Zip---------......... .. Address-.._"._ Contractor's Name—--- Installation "Re ---- License #-1.01K _ ----- Phone.:_Installation will serve: sidenceApartment vus� ❑ Commercial ❑ Trailer Court M tel ❑ Other..... xj Number of living units:................Number of be ooms-... arb�age Gtinder__-,..-.-.--Lot Size--_....- " --Private ❑ Water Supply: Public System and name.. Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material.. .... .. if yes, type_ "" - f "6uiliiings; etic—must be placed on reverse side.) (Plot plan, showing size of lot, location of system in relation"to wells, GJ NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is' available within 200 feet, : �� Size... - - f -- ---- Liquid De th _�--------------•--- PACKAGE TREATMENT SEPTIC TANK Capacity,-]...AffoType Material.. _��( ------- -No. Compartments._..i ------ Pro Line- Distance to nearest:.Well------------------ ---- --- Fouridation._.._...-. p• i LEACHING LINE C ] Na. of Lines --------------------------- Length of each ling....-------------------- -----Total Length . .........-----;-" ....-- t k 'D' Box_.......:,Type Filter Material...... .... .....Depth Filter Material"-... -- -- Distance to nearest: Well--------------- ------ Foundation----------------------- Property Line.------------- ----------------_--. SEEPAGE PIT [ ] Depth- . . - Rock Filled Yes No El . .biometer.----------�..- ----Number ---------- ----------•------- ❑ Water Table Depth-------------- ----------- Rock Size. # Foundation......- ------ ...:..Prop. Line----- ... ............ Distance to nearest: Well.--__-------- �°� Date------- -•- ------- --] REPAIR/ADDITION (P(ev, Sanitation Permit#.._-.._-------- --------------- ------ ;_ r:• ------ ----- Septic Tank (Specify Requires•rents)-""..---�.----��- ---- -•'-' -'"" . r Disposal Field-(Specify Requirements)..... -- - _.. _ - --.- I . �n N_ , j (Draw existing and required addition on reverse side) f:._. y I hereby certifthat 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 Heaith .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." t Signed-- 1-1------ ----------- Owner --------- ------- ... ...:Title ----- [ f ah r t on owner[ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -- -..7 ...-..- -.....--"......DATE --------- -- DIVISION OF LAND NUMBER ............. . ADDITIONAL COMMENTS----•--- -- - --- ------ ------------- _._.... ._.... - Date . . . .... .---- . . .•-. Final inspeiaion by:---- . - - F&S 21677 REV-7/76 7M SH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT