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t-FOR OFFICE USE: FOR OFFICE USE: APPLICATSON FOR SANITATION PERMIT -- ----------------------- - -- ------.• Permit No..7�~�l (Complete in Triplicate) � -------------- •----------- --... . Date Issued_./."a,-. ___......__._....... ...... This Permit Expires I 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 exist ing.Rules and Regulations: f / ...---.CENSUS TRACT.----.. 5... . JOB ADDRESS/LOCZ11 N...�� y3 -- �......�1��.e.�.[?/�....._�C'.'---- -- - / � Phone.__. -------_-------$ to�i-... Owner's Name......._ &)......`i� C.C1_..... ------ � Address----------- ...... 6.9.�---- f� C' �r.l `....._. T City- p Contractor's Name........-... Wn .:. .: � �„ --...License #-.----- ..Phone------------------ ------ -------- . Installation will serve: Residence ❑ Apartment House ❑ (Commercial ❑ Trailer Court ❑ Motel ❑ Other.. Number of living units:.....--:---•--Number of bedrooms..- Garbage Grinder-.-.-.------Lot Size---.--CC 5— -�L- ...............--- _ --- --------•----.Private([ Water Supply: Public System and name.. .... . ...... . ....." Character of soil to a depth of 3 feet: Sand r-) Silt❑ Clay ❑ Peat ❑ Sandy loam El Cla Loam x Hardpan ❑ Adobe ❑ Fill Material.. _If yes, type----- ----------- --- (Plot -(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,! PACKAGE TREATMENT [ ] SEPTIC TANK [�] Size .. .. -- ---------------- -----.Liquid Depth..-. `Z .... .. - }- !%_."No. Compartments t Capacity---.l Type Mater�al. n,2C . Distance to nearest: Well.-.. .. ....... ......Foundation---------1. ..... _.Prop. Line- >..3.. ---- .-------- Length of each line----7--Q---------- Total Length LEACHING LINE ( � No. of Lines ...... Depth Filter Material...-I 2_rl----- --- - 'D' Box..�Q,�- Type Filter Material�EP�. � p Distance to nearest: Well... - -Q_ - - --- Foundation...-._. (� - Property line--- .......-- _. SEEPAGE PIT [ } Depth_.............Diameter.----------...".....Number.._.---- ------ -.. . - - Rock Filled Yes ❑ No ❑ ..-- ---- Rock Size............. Water Table Depth--•---•• ----•--- •------- - - - - - Distance to nearest: Well--------------------------....... Foundation..... .................. Prop. Line..---- --- ----------- REPAIR/ADDITION -- -------REPAIR/ADDITION (Prev. Sanitation Permit#----- •------------------- ---- ........Date--.-------------------- ---- ----------------- Septic ---- .------Septic Tank (Specify Requirements)....-- - - .----- -- ---- ------ ------ - ------- 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. Home owner or licensed agents signature certifies the following: "I certify that4E, he performance of the work for which this permit is issued, I shat! not employ any person in such manner as to become to orkman's Compensation laws of Cali€ornia." 1 .._....Owner ..... Title,. --------- ----- - (If other than owner) FOR DEPARTMENT USE ONLY ! APPLICATION ACCEPTED BY---- -.... DATE `-�- .�Z. 7... ...... 15--- DIVISION OF LAND NUMBER DATE.- _.....- -----=------ ---- - ------------ ------- -------- ------- ......-... ADDITIONAL COMMENTS-- ---..... ------- ---------- --- •-----•---------:_:_1------------- --- ' Date... '--c�.:u . . ti Final Inspecon b F&5 21677 REV. 7174 EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT