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FOR OFFICE USE: N FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT i i (Complete in Triplicate) Permit No. _ _ Date`issued.__7_-/T-z'--A5 ---------------------------____________ __._-.-_ 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. d This application is made in compliance with County Ordinance No.549 and existing Rules and Regulations: JOB ADDRESS/LOCATI --' `L__. `'fir}--- ---- - ------.CENSUS .TRACT.--6----------------------- Owner's ------Owner's Name.- ---- Phone_ - , -. --- -- -k -- -"`�' " Address/ - Q._ ad_` _�..d �Ci - _ -d Zi ------- city p-- _ if Contractor's Name--------------------- `License #_ 5_ *Phone_'7� 5 -r / --- i Installation will serve: Residence [ Apartment House.❑ Commercial ❑ Trailer Court 0— Motel ❑-• Other-- ----=--- ------------------------------ ---- Number --Number of living units:-----X____Number.of bedrooms ---Garbage.Grinder------------Lot Size------ ---------------Wdter Supply: Public System and name ._,-- ---- --------- ---- --------------------------- ---------= ------------ ----- --PrivateK, 4 Character of soil to a depth of'3 feet: ' Sand [] Silt❑ Clay ❑ , Peat Sandy Loam-❑ Clay.Loam ❑ Hard ❑ : ❑ Fill Materia!_. If yes,. an Adobe. -------------- (Plot plan, showing size of lot, location of system in relation-towel Is, buildings, etc. must be placed on reverse side.) i NEW INSTALLATION: (No septic tank or_,.seepage pit .permiited if public sewer is available within 200 feet,] PACKAGE TREATMENT [ ] :,SEPTIC TANK - ---------------------------------------------- Liquid Depth--- .Capacity#__- = Type"-_--?-=----=-= `---Material--------------------------No. Compartments------------------------------=-- a i 'Distance to nearest: Well-------- ...... _-__-- = Foundation Prop. Line 'i LEACHING LINE: [ ] No. ofLines.c�----: _ -_?- Length of each line _...__ ,..-,._.,Total- Length ..--- ---------------------------------- D''Box_:-':-------TYPe Filter Material'--------------:-----Depth Filter Material------------------------------ -------------------------------- .' E . Distance to nea. rest: Well-:-- - �� ----------- ---Foundation-----------------------------Property Line------------------------------- SEEPAGE PIT [ ] Depth- _-- .Diameter-/--------- ----Number---------------- - ' " f' - - ' ' ------- ------ ------------- -------______- Rock Filled Yes ❑. No Water Table Depth. -. ;--------`-- ``-- }Rock Size } • Distance.to nearest: Well4'-------:--`_--------. -``"'---------:Foundation--'-----------------------Prop. Line---------- - -- -- i-- ` REPAIR/ADDITION (Prev. Sanitation Permit#__ -----h----------------------------------Date----------------.-- -----) Septic Tank (Specify Requirements)'- = _ ------------ Disposal Field (5pecify'Requirements]--- � -----=----- ------------------ ------------ --------- ---=---==----=----------- ' '--" ---- -- -------------------------------- ---- l ______---------------_-------_----___ _____ -------- __ ___ (Draw exis' fing and required`acJdition on reverse side] �. I hereby certify that I,havemprepared this application and that the work will be, done in -accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of Ithe San Joaquin Local Health District. Home owner or licensed agents signature certifies the following: r [ F i "I certify thacjri`the performance of the work for which this permit is issued, .hshgll n t employ any person in such manner as to becam jec to-Workman's Compensation .laws of California.'.. d Signed i ^-- O ------ wrier BY; - - -- _Title-- = ---- - �-......b: -:---------------------------,F:�----- ( w � If otter than owner) FO D RTM N i J; o.:.., ►;, .. T�USE ONLY _ �.�.. . .a,,�, ....,.-..� ... APPLICATION:ACCEPTED,_BSL — -- '- .._ = = -=DATE.- -- DIVISION OF LAND NUMBER '-------------------- _-.DATE____--------------___ ADDITIONAL COMMENTS-------------- ------------------------------------------------ w „ -------------•'------=------------------------------------------------------------- ----- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I — C/ ---------------------- ------------------- - ------------------------------------------------------------r----------------------- --------- ------------------- Final-Ins ection-b - -� -� Date:____ ----------------- 1: - EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT 77 REV. 7/76 3M