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I �ooC� .�un ,f �'" � 2 f � . WFOR'OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 77` �� ---------- (Complete in Trii�ilicate) Permit No-----__ ___ __.__ ------------ -------------------------------------------- t �7 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 County Ordinance No. 54 ---aex --------ules and a ulations: JOB ADDRESS/LOCATION-_1_4__(v:__- - -�SUS TRACT - ---------- Owner's Name - - ------ ----------------------------------------------Phone------- ---- Address-----------------------/- ------------------------------------------ City------------------------------------------------ Zip - L_-�- --- ---------- Contractor's Name---- _ .y�J � _' ___ ---------------------------------------License #� ®� ___Phone_��_=7At_ 6'_.. Installation will serve: 61 Resi eent House ❑ Commercial ❑ Trailer Court Motel ❑ - Other----------------------- ---------------------- Number of living units:_._ .____-___Number of bedrooms__/-------Garbage Grinder----.-------Lot Size--------------_---------------------------- -------- ------- i 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---------- yes, type-------------------------------- (Plot plan, showing size of{lot4oco dings etc. must be placed on reverse side.) O G NEW INSTALLATION: lo septic tank or seepage pit pCrm atted if public sewer is available within 200 feet,) cj F PACKAGE TREATMENT,,:`] ASEPTIC TANK [ -----------------------------------------------------------Liquid Depth_______________ t c;tpaGity l+01P_ _ _-- e_____________;_--- Material------.------------------No. Compartments------------'_'______-.--=� ` - --------- (� tance to nearest: Well______.._____._ ______.__.__________Fou ndation__�P_________________Prop. Line.c�----__._ IN LEACHING LINE [ ) silo. of Lines------------ ----- _..Length feac line _ __ ________ Total Length _.. -- e Bo c -------Type Filter Material.. . Depth F�6' ter Material_ -o---.-_ .— '~ Diktarlce to nea est: Well------------------ ------Foundatibry__ -_.-___._ -_--_---.--Property Line_- -. __ ___ SEEPAGE PIT [ ] Depth:--- _ D c9e x 4 - lumber -_ ? Rock Size._.____--- Rock Filled Yes ❑ No ❑ Wrater Table,ph`_______ __ a Et Di1starice to nearest: Well k `t 'r; I Fpndation__ ______ ___________.Prop. Line------------------------- ---------- 1 -- _ r REPAIR/ADDITION (Prev. 9anitltion 3 Permit# -r s_____..a ______________i_.Rate------. ) Septic Tank (Specify Requirmelts) y�► Disposal Field (Specify Require#rlents)--- `_ / -1- -------------------------------------------------------------------- -------------------------------------------------------------- ----- ------------------------------------------------------------------------------------- - �. 1 -- _` .---•-�'�T -C)E1'$$FFIg- ?�11jditi h an ro..crcc side) - I hereby certify that 1 hav4 prepared this applic%tion'4ns[;t he work will be done in accordance with San Joaquin Coun Ordinances, State Laws, ana Rules and-tegula4ns df-the San Joaquin Local Health District. Home owner or licensed agent signature certifies the foll6wi"g: "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 become sublerj to W rkmanIs Compensation laws of California." elpSigned-- .V.-�- - ------------ ---------------------------------- By-------- ---------------------------------------------------------------------------------------------Title---------------------------------------------------------------- -------- (If other than owner) FOR DEP6VMENfjUSE ONLY APPLICATION ACCEPTED BY_- ____ ---.DATE.___-._'' ___ ___ DIVISION OF LAND NUMBER. ---------- DATE - -------------- ADDITIONAL COMMENTS --------------------------------------------------------------------------- ---- ------------------------=------------------------------------------------------------------------------------------------------- Final Inspection b Date. P y:--------------` - ------------------------ EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M