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FOR OFFICE USE: FOR OFFICE USE: APPLICATION F-,f a SANITATION PERMIT F% Permit No._-7-7-A-�- (Complete in Triplicate) --------------------- 3-�s - 7 2 ----------------------------------- Dd#e 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 County Ordinance No. 549 and existing Rules and Regulations: CENSUS TRACT JOB ADDRESS/LOCATION-... _ .. ' ----� -- Owner's Name I - -----------Phone-------------------------= ------ Address------- ------ moi City z - Contractor's Name-- -- - License #_ _ �. �� Phone-.. Installation-will serve: Residence EJ Apart ment House ❑ Commercial Trailer Court El :. Motel ❑ Other------------ - •... /:.._ �- Number of living units:-___.."__._.-_Number of bedrooms-- -,=-Garbage Grin der...-___-....Lot Size.... '...- �- i 1 - 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 Y YP l� Fill Material... If est e..--_..__-.-- (Plot plan, showing size of lot, location of system in relation to,wells, buildings, etc-'must be placed on reverse side.) NEW INSTALLATION: (Nonseptic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size.e-.�.----- -: -' ---'--------- -----------Liquid Depth._. __ -- ----- Capacity. �� - -TyP -- - ------Material _1_S 0. Compartments.------- Q---------� ` _ - r Distance to nearest: Well-----— -- ---------------------------------....Foundation------ __I?-----------.Prop: Line-----_-...__-----------`-=-` LEA f h line--- f�� Total Lth._ ©p 1 1CHlNG.LINE Do BaxLin'-"es�-Type Filter Mate Length ,�? Depth Filter Material._---. -_-..--------------------------- { 1 -Z / - A Distance to nearest: Well_.•1 Gd- oundation----,-- ©--------=---Proper#y Line----------------- ---------------- �'L . / 7.1. j e N ---Diameter------ Number / Yes SEEPAGE PIT �;]. Depth_ ---- � Rock Filled o D Rock Size:------ --- - --------- --.._------------------------------------ n -'-------------------- ..� Water Table Depth_:_:.. ----- � �- -- ----- � ------ _ �© ---------- _§" -- ` s Distance to nearest: Well-- -- Foundation--.---..-.-- Prop. Line------------------ I _REPAIR/ADDITION (Prev:Sanitation Kermit#---------•--------='---------------------•------------Date- ----------- -------------------- ----------- a --------- ------------------------------------ - --------------------- -------- --- Septic Tank (Specify Requirements)'--- ---=------------ -----------------------_ Disposal Field (Specify Requirements)- -----=-------------- ------------------------------------------------------------ ----- ------------ --------------------------- = - ----------------- ---- - - -F ------------'-- ------------------- - .- ------ ---------- -------------------------•-----.----------------- ---------------- ---------- - p R � � •J � (Draw existing and required addition on reverse side) I hereby certify that,l 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 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, 1 shall not employ any person in such manner as F to become subject to Workman's Compensation laws of. California." ---------r------------- --- ------------- OnarSigne --- --- ---=------------- ----------- _.Title-----' E (If-other than owner) . t F OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ---=--------- - ----------- DATE.` 7 4 DIVISION OF LAND NUMBER:---- ------ ---- - -------- ------------ -DATE-------...--- ----------------------------------- ` ADDITIONAL COMMENTS------ --------- -------------------- - ---------------------- -------------------------------- a ------------------- ------------------------------------------------------------- ---------------------- i ------- ----------------- ------------- ------- ------ ----------- = ------------ -------------------------- a-�r ........ �.. - �- Date Final Inspection by:--- ----- Fas 21677-- REV. 7176 3M EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT