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FOR OFFICE USE; "' FOR OFFICE USE; APPLICATION FOR SANITATION PERMIT --------------- --- --------------- Permit No._� --3d%� �- (Complete in Triplicate) Date Issued-------------------- --------- ----------------------- ---------------------- 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 CountX OrdipaTce No. 549 and exist' Rules and Regulations: - - ------------ i // O' � -- _ CENSUS .TRACT. JOB ADDRESS/LOT10 .�_ tl- _,_.-,___ __ � �j i Owner's Name. ------------------------------- ------ ----- Phone -------------- ---- ----------------- Address ----_Ci ---- --------- ------ZiP Contractor's Name. -�C.�---- _. -_ --�-- -_�--------.------License # -----------------------Phoned'__` ___.__. g Installation will serve: Residence Apartment House.❑ Commercial ❑ Trailer Court ❑ [ _.... r Motel ❑ Other---- ----------------------------------- Number of living units;----------------Number of bedrooms_;,.,----Garbage Grinder-__,-- ____Lot Size-------- -^___------.___---------- ------------- _____ Water Supply: Public System and name---------------- --------------- ---------------------------------------------77------------------------------ -:,.----------------Private �.-- Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ . Peat ❑ 'Sandy Loam ❑ Clay Loam Ems} { t Hardpan ❑ , Adobe ❑ . Fill Material _-If yes, type-------- (Plot plan, showing size of lot, location of system in relation to 11 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 [41-- ' Size__. __ _ `------- -_Liquid - � lf Depth..._ ��- CapaatY--f�� Ype -_--- - -No. Compartments Distance to neare Well _ l _---------_.__.____Foundation f- _________________Prop. Line._��___________-.__ LEACHING LINE [ No. of Lines_______ ___ ____,3-:_.__.Length of each lina._____Z_p_.____-------.__.Total Length._----��p___-___-__,________.._ 'D' Box . y-Type f=ilter Material-!-- �//-bbepth Filter Material_._____�__________________'----.----------------------------- Distances _____---_. ' 6 A� Distance to nearest: Well_____`.----------------Foundation__11.57 ---------------Property Line---- .___________------:--- ' rte, . 1 - -.. l SEEPAGE PIT [4 Depth_ ____Diameter-. 1�_-____Number_.____.�__________________ Rock Filled Yes�No❑ . E9 `� �. .. � - •. -. Water Table.Depth-------��-=--- ----------- ----------------------Rock Size-------1 --- ------- -�--------- 1 t Distance to nearest: Well----- -------------------------------Foundation_- 1;: -- ---- Prop. Line... ---------_.- REPAIR/ADDITION (Prev. Sanitation Permit#--------------------I-----------------------------.Date----_------:------------------- ------------1 Septic Tank (Specify Requirerf)ents)------------------------------ - ------''----------------------------------------------------------------------------------------- .� Disposal Field (Specify Requirements)--------..�._.._______ I. -=-------------- -------------- -- f .- --------------- --------------------------------------------=--------- y `--- --------------- ----= ' - � z a . { i (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, and Rules and Regulations of they. San•Joaquin Local Health District/Home owner or licensed agents signature certifies the following: ►�� x T "I certify that in the performance of the work for which -this permit is issued, E shall not.employ any person in such manner-as f to become subiect to Workman's Compensation laws of California.'" A 4 Signed------ --- -------------- :-- ---------------------- --------------Own ers -----<Title.... -------- - - If other than owners _ ' fOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _.: ---------DATE._. ' ; DIVISION OF LAND NUMBER. - T---------- ------------- DATE J ADDITIONAL COMMENTS---------------------- ----- l -------------------- - ----------------------------------------------------------=--------- ---- ------------------------ -- ------------- i to -- ----- ---------- --------------------------------------------------------- - --- ------ --------------------------= ----- --- Final Inspection b -"� -------------, ---- ----- - - --------- - P Y------'---- -- - - -= - ��-�✓� ------------------------------ ----Date ---- ...... -=------------------- ----- EH 13 245AN JOA IN LOCAL HEALTH DISTRICT &5 21677 REV. 7/76 3M .• l _