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FOR OFFICE USE: FOR OFFICE USt: APPLICATION FOR SANITATION PERMIT _:-- Permit No...7.r - (Complete in Triplicate) ' ---------------------- ------------ Date lssued..f..." -?- 7L1, i .............................. ............. 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: -.CENSUS TRACT.----.... JOB ADDRESS/LOCATION -®... - -------- r Owner's Name... Phone � --i��/ �z ..- s— Address....��J.46... le? ._..,....... . ........ ---- ..._..:..- _...City - dip ' ...( Contractor's Name.. ...'-. [ --License #.Js�39.1�_.....Phone__��,-S.: '... . I Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ 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 [I Silt(] Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan Adobe'o Fill Material.. ..__ _...If yes, type-..-...-- -------- _... i (Plot plan, showing size of lot, location of system•in relation to wells, buildings, etc. must be placed on reverse side.)' NEW INSTAL;ATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) f �` r q p /. cf PACKAGE TREATMENT [ ] SEPTIC TANK [ S�iz—e-. ./�.----- --j _� -� - ---------- -- ----Li uid De th.-.------- ---------;\ Capacity --"--- yp I !� `'! Material_..� 41w'-----No. Compartments........:..... � ... --...0 -T e ......... Founda#ion...l..d- ...Prop. Line..- .. Distance to nearest: Well_:._-........ . . . . (� ----------..Length of each line.yv � -�� _....Total Length LEACHING LINE [� No. of Lines;... ...--- __ - D' Box... 'Type Filter Material.-�/�dC -. Depth Filter Material......,- ------ -� Distance to nearest: Well--- _r... .... .......Foundation---a�--1------- -....Property Line...5-'.-. -.----_--• y SEEPAGE PIT [l� Depth"aZ- - 'D'sameter.. .v2 .._ Number..- �------------ --------ee Rock Filled Yes 41 [5�No El F Depth . -- .. ./r .... -Water TableDe thr .-/QQ-------�.-..-------------------------Rock Size. Distance to nearest; Well._/00- ---- ------ r . C ....Foundation.._..�-Q--'........Prop. Line...s----------.-------- REPAIR/ADDITION {Prey. Sanitation Permit#---•------------ -- ------------_Date--------:------------------------- ----------1 l Septic Tank (Specify Requirements)------- -- ............. .--- -- -------- ..._... Disposal Field (Specify Requirements)- ------- . -•-- ---- ...._--•---------------- ----- --- - ---------------------------- •-----. ------- -•---- --------- - i+ r .........................................'•----.........__._...........-------."-------------.............----_-....---.......-..-.-....------ i (Draw existing-and 4required addition on reverse side) k 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 licenied agents signature certifies the following: "1 certify that in the performance of theYwork for Vwhich this permit is issued, I shall not employ any person in such manner as to beco es jec to Wo an.s Compensation laws of California." " Owner Signed.. $.` - �. Title.---- --- --- BY ............ ---------------- (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY...._ --..DATE --- � - DIVISION OF LAND NUMBS I - DATE. - ----------- ADDITIONAL COMMENTS. e!-rs... .................... ---------------------- --------..._......................... ......... --- ... ------•"----------------------------- --- -------------- ---------- ----------------------- -------------- ---------------- ----- ---- --------- ---- I . ----..... � Final Inspection by: . .�.�.... ------ --------------------------- ---- - Date f.� -..� .._ ras 21677 REv. 7/76 3H EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT