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sy ``` FOP."OFFICE USE: FOR OFFICE USE: 4 APPLICATION FOR SANITATION PERMIT -�a ------- - � (Complete in Triplicate) Permit No------------- --------- -� } ----------------- ------------- - Date Issued-�.- ./---!I--7-- - .2 This Permit Expires 1 Year From Date Issued Application is hereby mode 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/LOCATION.... 1 ------- '=....°!r .1�.1.J ---------.....------------------------CENSUS TRACT------------------ --- ------ - ?92-0366 Owner's Name:_...:^. . : . . Phone - -------------- Address ---------- ------ IX r.- ------- ..... -- _-- Cit l+la'rI -. -Zi `� . - -- -- -------- ---- Y P -------- Contractor's Name _.- - .................License # -------------- -----Phone...------------- ------------ F Installation will serve: Residence ❑ Apartment House ❑ Commercial [❑ Trailer Court ❑ 10sire,- -�Z343YS Motel ❑ Other-.._. f7�`,�. O�r�-�•- ... Number of living units------I-------- Number of bedrooms_a- - ...-.Garbage Grinder.-----------Lot Size.-----.�J.-'`_/0c-!7r._ ............ .. Water Supply: Public System and name - ----- -------------- ................ -_---------------------- ....... =-------- ...-.-.Private Character of soil to;a depth of 3 feet: Sand ❑ Sift❑ Clay ❑ Peat ❑ Sandy Loam,W Clay Loam ❑ • iHard pan ❑ Adobe ❑ Fill Material.- -... ....If yes, type------------------_...-------- - F - (Plot plan, showing size of lot, location of system in r Ginn 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 O SEPTIC TANK J} ' Size-------------------- -------------Liquid Depth-_:- ..._-.-.....--..6 -- - ,Capacity.._� �.c. �l:TYPer"L �' t-.Material--Cnp_Y- .-No. Compartments----- ! _--------------------C 3 Distance to nearest: We!!_-......-.�------------- -----------_-Foundation.----lD. . ...._... ...Prop. Line--- �..------.--- -.�- 3 LEACHING LINE No. of Lines ..t'-._ . r • / ---------------Length of each line.------�-�-- - ------ -- Total Length .. ..�._ ,..�- - - -------- 'D' Box-- -C. ..:Type Filter Material_.__t 4 1�._.. Depth Filter Material---------...---GIfl...-------- --...-----.--.___...-------. _ �:".Foundation f ` / . _. Distance.to nearest: Well------ -_. . _.".Foundation------10-t--...-- -...Property Line...r'V--bb -- _--.-. w. !. :SEEPAGE PITS ( ] Depth_.._.. -_- _..Diameter--- -----------------Number.'_.---------------------------- Rock Filled Yes ❑ No❑ Water Table Depth-------------------- ------ -- - ----.._.--.Rock Size...................................=------------ Distance to nearest: Well----------------------------------. -.'J___-.Foundation-------------............ Prop- Line---- .---------.------_ REPAIR/ADDITION (Prev. Sanitation Permit#----------------------'----.-------- ----------'...-Date-----------------------.-..-----------.------) Septic Tank (Specify Requirements).... ----- ------------- Disposal Field (Specify Requirements) ---- --- ........ ••------------- -- -- - ----------------=--------------------------- - -------------------- l (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 3Rules 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 permit is issued, I shall not employ any person in such manner'as to become subject to Workman's Compensation laws of California." Signed-- -------------------------- -----Owner By ' --------••- Title (If other than owner) iEPR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---_-- -- -l`-. - - - ---------------------------- ------ ----- 7.7---- DATE ._.__ `- ..- " -- -- --------- -.- DIVISION OF LAND NUMBER-----_ ------------.....DATE.....---------~-� -"-'-- ------------------ ADDITIONAL COMMENTS...-............ - ------ - ------------------------------- --------------- ....... . - ---.- ------------------------------ :----------......----- ------------ -- - ---- ...... •------------------------------ �, - - Final lnspecnon 40y------------ --- - - - - -- --------------------- ---- -------....--------- ..Date.----- , _ - _ ._... .. EH 13 24 E r ` -C05 � F&S 21677'REV. 7/76 3M SAN JOAQUIN LOCAL HEALTH DISTRICT ll..//� ,