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FOR OFFICE USE: FOR OFFICE USE: ' 'APPLICATION FOR SANITATION PERMIT ; .., ---•---•------ - '..� r PermitNol...( .+ (Complete in Triplicate) -----.------------------------------------ .... / f Date Issued-lo.:-6-n 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...._crR.L.3.9- ...TO.A.hRC�k►:....1�+�........ ._.CENSUS TRACT t f .1--- .Phone...7_.`.5.�.a -... Owner's N.ame......? k t...B.,..O t'.Dra.e......... = _. . _ Address........... ��.Ur.'. O.X.- .. ......... .............--...City._ L�i �u e�.7�5_....� Contractor's Name------. . ............. License #------- ----------- . .�...Phone-------=----------- ----...--- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other....1�?.�-,�2r��P.. .tat-F---- • Number of living units;................Number of bedroom s.cl_,....Garbage Grinder_V f----Lot Size-------- ............ ... .......---- 1 Water Supply: Public System and name:_!_..... f_t.t -�....'.._.- ---..._. _ Private ❑ I Character of soil to a depth of 3 feet: Sand ❑; Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan L4,," Adobe ❑ - Fill Material.. ... ....If 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 seepagepit permitted_if,publ'1c sewer is available within 200 feet,] d f �1 PACKAGE TREATMENT [ ] SEPTIC TANK K Size 5�-- -- - .. ----Liquid Depth...`- -----------:� ----------- Capacity..1".Q------TYpe._C !.A aterial---------- -------------No. Compartments -----C91 ....-- Distance to nearest: ell---. ------.'-.- - .........Foundation----- . ----..... --Prop. Line..... ............. .. LEACHING LINE No. of Lines ...... Length of each line.-...-44......--...._ ---Total Length .. .... ------- ---- -------5' D' Box-..�.....Type Filter Material - .De th Filter Material........ 4_--- ' p e ----.../...-------- F Distance to nearest: Well �Q -_...-.- ..Foundation.----_.�-�� ----Property Line..._-- -- -- -saw SEEPAGE PIT Depth-- .........Diameter----------------.:---Number-....-- •--------- Rock Filled Yes ❑ No I 1 ----....Rock Size----- ----------------- lo ---------- -- 11�ater Table Depth.------•- ------------- --=--- ------- ---------- ... f, l° ,f ?r Distance to nearest: Well.-------"-- ---- ... ...........--......Foundation.-....------ _.Prop. Line---- --------- - ------ i REPAIR/ADDITION {Prey, Sanitation Permit#----------------------------------- - ........Date-------.:--------.----- ------- ------------) i Septic Tank (Specify Requirements)-- ----- ------------ .........._....... . r I Disposal Field (Specify Requirements). ................. ---- ------ ------ ------------------------------------------ ----• - . .............. ......... ---- ---------------- ............... --.... . --- - - ••-------- (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 the ,San Joaquin Local Health District. Homeowner or licensed agents signature certifies the following: "I certify that in the performance of the'work for-which this permifis issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." d Signed--------------- .- - ..:.--.. .........-_Owner-4 ---------- ------ BY -------------------- - . , :. . �_. Tit e . (If other than owner] ' IFOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ------ DATE .---"-- DIVISION OF LAND NUMBER........ ............... ----------- ----. DATE - ---- ---------------- ADDITIONALCOMMENTS ----------------- ------------------------------ ..............-"-----------------------------.-- ............. ......... -, -----........ V .. - -t..- --------------------------'---- ------ --..... _.. , 4 --------- d. - -' - -- ----- -'- ---'r--------- - I Final lnsgectlon b ' ,G ,c� ---------- a i EH 13 24 SAN JOAQU LOCAL HEALTH DISTRICT F85 41677 REV. 7/76 3M