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FOR OFFICE USE: 1.4 -FICE USE: APPLICATION FOR SANITATION PERMIT ------------- ---- ------ Permit No.72- (Complete in Triplicate) I Date Issued.//-5-e77 i This Permit Expires 1 Year From Date Issued J ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work he;-rein described. s application is made in compliance with C my Ordinance No. 549 and existing Rules and Regulations: A / . 1 � --- ---- ---- ---.CENSUS TRACT--------------- JOB - ---------- JOB ADDRESS/LOCATION---_.-._ ------ Phone _ . - f---�---- ... - .------- - Ower's Name----- -------------------- { �r--�-- - -----Z1p__R5_ rZ -- . Address_-__------- r Contractor's Name----- 6� ---- License # Phone- --- ---- --- -------- ----- - ---- -•------- _ Installation will serve: _ Residence ❑ Apartment artment House F1Commercial [j Trailer C-ot,� yMotel ❑ Other------------------- ------------------- ------ Number of living units: ------ _-----Number of bedrooms..---�_.-Garbage Grinder_.---------Lot Size_--__ `y----------- -------------- ---- _ -------Private ❑ Water Supply: Public System and name------ -- ------ ----------- --- -- Character-of soil to a depth of 3 feet. Sand [ISilt❑ Clay ❑ Peat ❑ Sandy Loam El Clay Loam. y t Hardpan X Adobe ❑ Fill Material_..-.- ---If yes,type----------------------- ------- w (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,) g ----- --Liquid Depth.-�_-�-----------k-Y PACKAGE TREATMENT [ 1 SEPTIC TANK 1W size--___0-.-�--r- -` �� O Material.-L'��'�'`'t'---------No.-Compartments - ------ .� Capacity----- ---------- -TYPe�'�'---- Y / , Distance.to nearest. Well__l�--------------------------------Foundation._/�---�--- -- --Prop. Line--.S-'-�--------------+� LEACHING LINE N _ No. of Lines-----�-- ---.--.Length of each line_.S~O,__.- Total Length:'-/° -. y � _ pp 'D' Box-'Y-----Type Filter Material-A`-."f -Depth Filter MateriaL.__�-`--------------- �y 1,"'- _-- Foundation . l.D--- ( -- Property Line.-T-4- Distance ---. ------- F Barest: Well-_/90-11 p0 - -- �- Distance to �--- j _-- -- ��- ...........'Number_ Z Rock Filled 'Ye .� No; SEEPAGE PIT 01 Depth--� � -Diameter-. � � �� " .. � .+ .-------'Rock-- Size_. �- `: ---- - -- -- Water Table Depth--�-�0-=�_�------- �---, ,a ; v Foundation--- 1d f - '..Prop. Line- Ste` �fss Distance to nearest: Well--- - -------------`---- - .--------------------------DaI ae----�_------------ ---------------- -_- REPAIR/ADDiT10N (Prev. Sanitation Permit#_..___----------------- Y , ---- ------------ Septic Tank (Specify Requirements --------------------------------------------------------- -----------E- ------------------------------------------- - Disposal Field (Specify Requirements)------------------- - -- --------�-------------- --------- ----------------------------------------=- ------------ --- --------------------- ------------------ (Draw existing and required addition on reverse side) s I hereby certify that I have prepared this application and that the work will be done in accordance with -San Joaquin County he San Joaquin Local Health District. Home owner or licensed agents Ordinances, State Laws, and Rules and Regulations of t 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 becom subject to Work an's Compensation laws of California.' Signed-_ _ Owner ------ ____ ___ --------Title------------------------------- ---------` ---- ----- (if ----------------- --- (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- t ------------------------- DATE.l,�.-". '_ DIVISION OF LAND NUMBER-------------_----------------------------------------------------------------- ------ --- ---- -DATE----- ------ ---------------------------- ----------------------- ADDITIONAL --- ------- -- ---------------------------ADDITIONAL COMMENTS-------- ------------------------- - -------------------------------------------- ---------------------------- -------------------- -�----- IC - --�---------------- ---- -----------------------------__- - '�- -------------------------------------------------- ------------------------ -�-�--- - -- ------ - y ------ �--- ------------------------ ------- - -- ------ - --- - ----- ------- Final Inspection b ------------ - - ------ - --- - Fay 21677 REV. 7176 3M EH 13 24 JOAQUIN LOCAL HEALTH DISTRICT