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FOR OFFICE USE: FOR OFFICE USE: a \APPLICATION�FOR-SANITATION PERMIT r -- - - - t. ,,_ tis ,�:.", . � G— 1F r [Complete'in'�Triplicate)� '�-� Permit No.-.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. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIOC23/ _•':116_�- ------------------------------------`------' E TRACT -- Owner's Name----- _ /J,, J �`r=� Phone !_-�---�--�-�--- r Address -3 �� - F--- --- �..=, C't Zi _ 7� Contractor's Name--- ___... ------------- ---- -- j Phone _ _-- 1 .: f P ,! '------- License '#_��-.- Installation will serve: -Residence [s�<', Apartment House.❑ Commercial ❑ =Trailer Court ❑ . : ---------------------------------------. ,.. . t -------------- --- - -- -Motel Q. • �QmboNumber of living.unifibedroom _Garbage Grinder__::_____--Lot'Size. _ ---------------------------------------------- Water �_ 9__ - ~_________ ,-_ a - Water SuppIY: Public System ._ --.`_ = -. r . Private Character of soil to a dep th of 3 feet. Sand ❑ Silt❑ .Clay ❑; feat ❑ Sandy Loam ❑ Clay Loam D - ardpan� Adobe;❑ _Fill Material_.. f If:Yes,type-------------s------------------- (Plot plan, showing size of, lot, location of system in relation to wellsjbuildings, etc..must be placed on reverse side.) ] NEW INSTALLATION: {No` septic tank or seepage pit permitted if public sew-is available within 200 feet,} t PACKAGE TREATMENT [] SEPTIC TANK [T] " Size___:____'_ -----------------------------------------4__-_' _-___ -_--__ __----'"_--______:__4__-_' iquid Depth__________________________ .} Capacity; ------ 'Type------------i-}' Material :-No.-Compartments- = "` - Distance,to-nearest. Well..==----------- --------------------------Foundation--'-----------------------Prop. Line `- F --------1 I LEACHING LINE [ ] No. of Lines---------------- Length of each ling .: _.;____,Total' _ !!� Foundation . . . . , .- s , Length-------------------- ------------- Type __._____,__ i __-__ _.___ TYpe Filter Material :____.Depth Filter Material '----- -- -------- k : -- - ' . ,D' Box ______ Distance to nearest; Well_____________ - -Foundation_-__-_-__.`------IJ Property Line-------- ---- ---- -- ------- '' . . SEEPAGE PIT Depth---?------------Diameer=- ------`-- -Numier---' - --"-.-------_-- ------- Rock Filled Yes❑ No ❑ _`_' Water Table De th--- ______---------------------------------- ---Rock Size------------------------------------ -- Distance to nearest:"Well_ -----' - - - --"" �________ '�------------=-------=-------------Foundation--=---------------------.Prop, Line ---------------------- REPAIR/ADDITION -REPAIR/ADDITION (Prev.!Sanitation Permit#--___-----_.._ Date------._ _-______] 1 Septic Tank (Specify Requirements)-------- = = t = Disposal Field (Specify Requirements):---C------ �-c__ ---- #- `- --- ------------------ ------ -----=------------------------------ ----------- - ; . -----=--------- ---------- --------------------=----------------=----- ---=-------'----------------------------- - - . . � --- ---------=---- (Draw existing and required addition ontreverse side) ✓ ^�n I hereby certify that I have prepared chis application and that the 'work will he'rdone�i`n accordance with San Joaquin County a 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'peirnit'is issued,' 1 shall no't employ an person in such manner as to become,. t t Workman's Com ensation laws of California." _ Signed----- ` ----- -- Owner BYE --- --Title--- - E - ------------ { (If other than ner) t j - FOR DEPARTMENT US LY'PF ' APPLICATION ACCEPTED BYE+____________________ _T --- --- - -- - - f --DATE G~�Z-7�, s - '= DIVISION OF LAND NUMBER.--'-------- ----------------=----- DATE #.._ ADDITIONALCOMMENTS ---------- ---- --- '-- - --------------------=-----'------------------------------- ------------------------------------------------------- 3 . ---:.. ---------------------------------- --------------------------- ------------------ ----- ----------------------------------------- --- ----- ------- ------ -- -------------------------- ---------------------- ----- - ------------------ --------------------- --- - _ Final Inspection-by:__ - - _._Date--------- --- ------------- __ EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21b77 REV. 7/76 3M