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FOR OFFICE USE: 06 2_ W I U FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------------------------- Permit No...7.7 (Complete in Triplicate) `..-________ = `- Date lssued__/ ./5e_77 --------------------------------------------------------- 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. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -------- ------ ------- CENSUS TRACT- Owner's Name s - -- ---------- ------ -------------- ------------ ------------- ��T 2 02 Sy Phone_ Address---1 - Q 1' -- Ci � _ -------- ------------------- Contractor's Name - / -------- ------- --- License # 7�. --'3�-------Phone__-5;1' _iZ;`� 14--- Instaliation will serve: Residence ' Apartment House.❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other--------------- ------------------ Number of living units:-----/-----Number of bedrooms_jc�..-_.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------------lf 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,) PACKAGE TREATMENT [ ] SEPTIC TANK P< Size-_.y/ s.X _________ -----Liquid Depth.___��__-_- /D �¢ ---------- Capacityw 0 0-------Type6e4'` _..-.Material----- -------------------No. Compartments-------.--ac_-----------------� Distance to nearest:Well,..�l-�__D-_.........__ Foundation___ _ --- �-- -�--------------Prop. Line----�-----��`-�"�,---- LEACHING LINE [� No. of Lines._��- __ _ .....Length of eac ina__ _ ____ __ ...Total Length.._.'-___ -----_.___ D' Box _ ---------Type Filter Material Sr_/?0.C'/V.Depth Filter Material______ --------------------- ------ . .... r � r Distance to nearest: Well, D�-_ --Foundation---0.�______________---Property Line---_c�--------------------- SEEPAGE PIT [4K Depth.-.o2 5 ...Diameter3. ,......Number- ------;Z--__--- Rock Filled Yes>' No ❑ r Water Table Depth------0. d}----------------------------------------Rock Size. ,_?2,w------------- -------------- Distance,rto nearest. Well._._-40----._...._1--------------Foundation__0.Q_______________ Prop. Line____c REPAIR/ADDITION (Prev. Sanitation Permit#-------------------------------------------- ---Date-----------------------...-- ---- --- SepticTank (Specify.Requirements)--------------- ---------------------------------- ------------------------------------------- --------------------------------------------------------- Disposal Field [Specify Requirements)----------------=---- - v---~----------------'------------------------------------------------------------------------------------------------------ ---- ---------------------------------------------------------- -------------------------------=--------------- -------------------------------------------- ---------- ------------ ------ z ---- x C' ------------------------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws„-dnd 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, I shall not employ any person in such manner as to becomp ubject to orkm n's Compensation laws of California,” Signed---- .-- �. ---� -- ------ ------- --------- ---- ----Owner Title------41------------------------------------------- [If other than own+sr] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- DATE ------------ ------------ - DIVISIONOF LAND NUMBER----- ---------------------------------------------------- - ----------------------------------------------- .......DATE-------------------- -- -- - ADDITIONAL COMMENTS------------------------------------ - - ------------------- ---- ------------------------------ ------------------------ Final Inspection b p Y - Date--- ---------------- ---------------------------- EH ----- -- --------------- EH 13 24 SAN JOAQUIN LOCAL H6ALTH DISTRICT F&S 21677 REV. 7/76 3M