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I lot ai 9 .•OR OFFICE USE: FOR OFFICE USE: PPLICATION FOR SANITATION PERMIT ................. Permit No.....7 -1/� (Complete.in Triplicate) t, Date Issued...3.-aJ - 7/ ...........................................:............ 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 o�t7.... . No. 547;and existing Rules and Regulations: JOB JOB ADDRESS/LOCATION............`TMC.... ..... ........0-9..............CENSUS TRA CT................. �..l...`........-. Owner's Name........ Jr.pi- .. ......: ............................................. ...... ........................Phone...".5; Cc Address TW. Zip..............................a4_ .. ity.. K � C �- Contractor's Name_....,Q.y.,�.,..F�i1,C•..L...,�.../�............................................License Installation will serve: Residence Apartment House L) Commercial ❑ Trailer Court ❑ c.. - Motel,❑ -Other.......................................... Number of living units:.... .........Number of bedrooms.-.-..Garbage Grinder............Lot Size......./......... .......... ... . .. Water Supply: Public System and name....... ...................................................................-........ . - ....................---•-------.....Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑. Sandy Loam ❑ Clay Loamj Hardpan ❑ Adobe ❑ 'Fill Material..........!..If yes-, type.. (Plot plan, showing size of lot, location of system in relation lo 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,) _ J/ PACKAGE TREATMENT ( j SEPTIC n�TANK [ '] Size..��Y.��GL......x.�.......................Liquid Depth ....'��..y........ ..... Capacity....�C-------type.P&46.e451�Aaterial No. Compartments......-�----- ....... .. . Distance•to nearest: Well.....6_Q.... '..................Foundation..1q....T.........Prop. Linef..3.Q...77....� LEACHING LINE ( j No. of Lines...... ................. Length of eacli (iris.....$U_f7 Total Length ............. L� Al 'D' Box....I...,..TYpe Filter Materiall L)"af!„�Depth Filter Material......�`�......................_.....................,Di4tance,to nearest: . T7 ......• undation,..�..--..... Property Line... 2 7 p ty r1«..................Q& SEEPAGE PIT j Water Table DeDiameter-----------f--------Number------------------ Rock Filled Yes ❑ No .........................Rock Size....................... - . ...............- Distance to nearest: Well........,..' _..Foundation..........................Prop. Line........................... • REPAIR/ADDITION (Prev. Sanitation Permit#...................... l -Date ---------- ..,..._..-......---------..........-........) I Septic Tank (Specify Requirements)......:.t......... '.: - -------------------------- •„ 5.......... ................ Disposal Field'(Specify Requirements)..........._...._... )' I � e � t ,Draw ezistirig and required addition on reverse side) 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`ana Regulations of the San Joaquin Local Health District. Home owner or licensed agents signature certifies the following: , "1 certify that in the performance offhe work for which this permit is issued, I shall not employ any person in such manner as to become subject todVorkman's mpensation laws•of California." Signed....--... .. . .........: ..............................-.......Owner � By......................................... ....................................................Title.-.... ....................................- (If other than owngr) l FOR-DEPARTMENT USE ONLY APPLICATION ACCEPTED BY:.....�... _.. ---------•---1-• .....................:.DATE .. 3.:��`^- 5.............. DIVISION OF LAND NUMBER....;....._.... " ....DATE........._............................... ION .. .. ADDITAL COMMENTS................`........... .....-....._-..,.. ..........---............,_........... ...._...... -- ..................... . .... - ........................................---------... - ...,..... ..........._ .... ----------•---.----.................-.-....................._........................... .. ... ............. .................. • ............. .:.......-............ ---.....----....................... -----------_... --.....I........... ....................---------...----............................. .. .................................... .................... .[..�.�...�..... ......-............ ........--- ._............................................................................................................ . Final Inspection by:................................ Date.. .-/ .-> . ak ....................................................... 3 f ...1`................. . EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&SV7 REV. 7/76]M