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FOR OFFICE USE: FOR OFFICE USE: r- APPLICATION FOR SANITATION PERMIT 1�3 :. ....... ....................._.. ........ (Completer Triplicate} Permit No. �yf ii Date ..........• .O I 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. 5 9 and existing Rules and Regulations: JOB ADDRESS/LOCATION. ...... ..P..L. .. ._ ...._. _..._.CENSUS TRACT. ..._:.....'.................... . ••. Owner's . ................ ...........Phone................................... ...- Address........ j( ................. ..... -------Ci 1..••. ... ...........zip---:.........._........_.•-••- Contractor's Name... ..... ... .. .. - �j,Q . License # .�- -L �.• •Phone.. �L/ ..� /k.. Installation will serve: Residence❑ Apartment House❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other..... ........................................ Number of living units:...... .......Number of bedrooms...11 Garbage Grinder...:........Lot Size..../ ..3- •�•-�--.. •• -• Water Supply: Public System.and name.. ................... .................__......................Private —Character of soil to a depth of 3'feet:t Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam (I Clay Loam (� L Hardpan ❑ Adobe ❑ Fill Material.. .__ ....If yes,type........................... .--- s]Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 00 ,NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} b- -'SEPTIC TANK Size.... 1T'PACKAGETREATMENT .........:.......Liquid Depth... _4_A./-Q .-.-. .Capacity -O._®...Type..`;;, material......lrll^- ------..No. Compartments._..__----_----------- ... Distance to nearest: Well----. ...+l!�.._. ... .... .........Foundation._._.lt✓ ..............Prop. Line.._.J�X_.�..._....._ .. LEACHING LINE wI ) No. of es`'.. .y .......—:length of each line....._._ .-, ,.. ��:. :.......Total Length .... _.. .�.................... ;D!8ox:-r�.....Type,Filter Material.:_....f. -.-.Depth Filter Material.....`. r.... ..................................... I s Distance to nearest: We(l_.: ---------------Foundation.....LOP............Property Line...,C.O..................... SEEPAGE PITS ( ) Depth.... .671.Diameter...-c�_ Number. ....._ Rock Filled YeS)f No ... ........... . .. Water Table Depth.........._...:.............. . .........................Rock Size-:.../-- - -- �. " ,. - Distance to nearest: Well.-— :�.�........................Foundation..........................Prop. Line................ REPAIR/ADDITION (Prev. Sanitation Permit#_................. Date__ — --_.--.-•.) .............. Septic Tank (Specify Req . ......... ..............................................:.................. Disposal Field (Specify Requirements). -_. ... ._.... •......... .... ._ .. �� ... .......................I....... . . ......................I............... .......... •� t t .................... ... .......................................... ............... ....... . --•----•----........................... --------- ........................... (Draw existing on`d required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations iof. the Son Joaquin Local Health District. Horne owner or licensed agents signature certifies the following: "I cern that in the I p P certify 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 By............... ° +r `:. ....--- -.._... Title....................- :....... (If other than owner) ; + FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY...... . ........... ' { DATE ..... 7. ......:............ DIVISIONOF LAND NUMBER.. ........ ............ _t._._ __...._... __.....ry_.._......_....._.DATE.........._............---..... ...---....:..._.. 11TIONALCOMMENTS.......... . ...........................................• ---••-----•----...... --------............_........_...---.......................... 4 ,..;,.. _R.-_A. ..79 .......... FinalInspection by:�j. ._...... .. .. .. . . .. .............._ ••---...---. - - - --- ---- ...... Dote...._......_.._... _..._.................. EH 13 20' SAN-JOAQUIN LOCAL HEALTH DISTRICT r F 21677 REV. 7/76 3M